Cleft lip and Palate Flashcards
What is the prevalence of cleft lip and palate?
Racial variation with 1:600 live births caucasian, 1:1000 african american, and 1:500 inuit.
in WA 1:830 (cleft lip AND palate), 1:1000 cleft palate only. Slightly higher prevalence in aboriginal Australians.
Are lip and palate clefts associated with syndromes typically?
Cleft lip and palate is not often associated with syndromes.
How does the palate typically form?
week 4 is when the pharyngeal arches form
1st contributes to mandibular and maxillary components and around week 6 and 7 you have the formation of the primary palatal components maxillary processes and frontonasal prominence. Secondary palatal shelves fuse and by week 10 the palate formation is complete.
How does cleft lip and palate form?
Failure of the palatal shelves to fuse is what leads to the formation of cleft lip and palate
What are the classifications of cleft lip and palate?
Usually described with descriptive terminology. There aren’t distinct classes due to the diversity.
What is the Pierre Robin Sequence?
Sequence of events leads to this manifestation:
Micrognathic mandible
Posterior displacement of the tongue
What causes cleft lip and palate?
Often genetic aetiology (70% of all cases of CL/P and 50% of cleft palate are non-syndromic)
Environmental aetiology (1.3x higher odds in maternal smoking. Maternal alcohol, nutritional deficiencies, stress, maternal obesity, ionising radiation.
Which genes are associated with cleft lip and palate?
MSX1 (involved in epithelial/mesenchymal interactions)
IRF6 (Related to connective tissue formation)
FGFR1 (involved in
How did antenatal diagnosis change CLP treatment?
40 -> 71% increase in detection of CLP between 1996 - 2003 -> 2003 - 2012
This resulted in increase in terminated pregnancies.
What is the aim of treating cleft lip and palate?
The ultimate aim of cleft surgery is that the patient look well, feed well, and speak well.
What makes treatment difficult for cleft lip and palate?
Treatment is complex and there remains extensive disagreement on the timings of interventions, the interventions themselves, and the various techniques involved in surgical correction of the cleft.
Treatment is multidisciplinary.
What is the treatment timeline for cleft lip and palate?
Short-term: Presurgical and surgical repair of the lip and palate. (birth up to about 3 months)
Medium term: Dental care, speech therapy, and surgical revisions.
Long term: Alveolar bone grafting and orthognathic surgery
What does presurgical management of cleft lip and palate involve?
Most kids with CL/P don’t need appliances to feed necessarily and are often under the care of specialist teams.
Feeding instruction
Feeding appliances
Methods of repositioning and aligning the bony cleft segments prior to surgical closure of the lip
Pre-surgical orthopaedics
What is the aim of pre-surgiical orthopaedics?
Repositioning and aligning the bony cleft segments prior to surgical closure of the lip.
Facilitate primary lip repair
What appliances are used pre-surgically in CL/P?
Intraoral appliance
Extraoral traction (bonnet/strapping)
How have impressions changes in modern times?
Digital impressions are now used instead and they are safe,, accurate, and faster than alginate.
What issues arise in feeding that are caused by CL/P? How are they fixed?
Difficulty creating suction, poor seal
Abnormally arranged oral and velopharyngeal musculature
Inefficient feeding (increased feeding time, weight loss/ slow weight gain)
Special bottles or feeding syringes can be used.
How is the palate repaired in CL/P?
Surgical techniques include:
Von Langenbeck palatoplasty
Furlow Z palatoplasty
VY pushback
What ‘well-baby’ checks can be used for preventative dental care?
Monitor to improve the effectiveness of plaque control
Professional cleaning and topical fluoride application
Dietary assessment and counselling
Fissure sealants to teeth at risk of pit and fissure caries
Early diagnosis and management of pathology
Occlusal development
Fabrication of mouthguard
What age should alveolar bone grafting and orthognathic surgery be used?
After 13 years of age
What is the purpose of pre-surgical orthodontics?
To provide optimal arch alignment prior to bone grafting
When is secondary alveolar bone grafting done?
Secondary alveolar bone grafting is performed after dental alignment and maxillary arch expansion
What is done to retained primary dentition adjacent to the cleft prior to the bone grafting?
Retained primary dentition adjacent to the cleft are extracted at least 4 weeks before bone grafting to allow for adequate healing of keratinized mucosa
How are periodontal and gingival tissues maintained in optimal condition before alveolar bone grafting?
Periodontal review and work-up to ensure gingival tissues are in optimal condition leading up to ABG, this includes regular use of chlorhexidine oral gel and mouthwash.
What factors are considered prior to alveolar bone grafting?
Before secondary alveolar bone grafting we must ensure correct alignment of teeth
Removal of retained primary dentition to ensure adequate healing of keratinized mucosa.
Periodontal and gingival health in optimal condition.
Where does bone come from for the alveolar bone graft?
ABG surgery conducted by means of iliac crest autogenous bone grafts in the majority of cases
What should be done post op after alveolar bone grafting?
Strict post-op oral hygiene and perio maintenance
Post op clinical and radiological evaluation
Recommencement of ortho treatment approx 6 weeks after surgery
