Cleft lip & palate Flashcards
What is oro-facial clefting
- This is the most common cranial facial anomaly
- Can be cleft lip, cleft palate or cleft lip & palate
- Cleft palate isn’t associated with any major dental issues while cleft lip is
What is the kernahan and stark classification
o Cleft lip - either cleft lip (CL) or clift lip and palate (CLP)
o Cleft palate - cleft palate (CP)
What is LAHSHAL
o L = right lip
o A = right alveolus
o H = right hard palate
o S = midline soft palate
o H = left hard palate
o A = left alveolus
o L = left lip
What does it mean if the letter is not capital in LAHSHAL
this means that the cleft is not complete
What is the incidence of CLP
1:700
What is the gender distribution
cleft lip with or without palate more common in males
cleft palate more common in female
Which is more common, CL or CLP
same in Scotland
What can the aetiology be split into
genetic
environmental
What can genetic aetiology be split into
syndromes
family history
sex ratio
laterality
ethnic distribution
What are the environmental factors in the aetiology
o Social deprivation
o Smoking
o Alcohol
o Anti-epileptics
o multivitamins
top 3 important
What are the implications of cleft lip and palate
aesthetics
speech
dental
hearing
other
When is the lip repaired
3-6 months
What is the impact on CLP on speech
Hyper nasal
Palate important in pronounciation of certain sounds: p and ph
What are the impacts of hypodontia on dental features
hypodontia
impacted teeth
crowding
growth
caries
How does CLP result in hypodontia
In area associated with cleft
Teeth near cleft may be small and hyperplastic
How does CLP result in impacted teeth
Can be prone to supernumerary teeth which can stop the teeth from coming through
How does CLP result in crowding
Top jaw is small and compressed so not enough room for teeth to come through, this is due to the scarring when the cleft is repaired weakening the upper jaw
The social demograph of our patients, many from low socioeconomic background, poorer attenders with higher caries rate which means deciduous teeth taken out earlier which can increase crowding
How does CLP effect growth
Class 3 growth tendency as top jaw hasn’t growth forward
Thought to be due to scarring from surgery
There is hesitancy to correct incisor relationships due to risk they will grow in a class 3 manner
How does CLP result in caries
Low socioeconomic background = higher risk
Teeth hyperplastic etc so increases caries risk level
What ear problems are CLP prone to
o More prone to glue ear
o More prone to hearing problems
What other problems do CLP px face
cardiac
feeding when babies
How does CLP cause feeding issues
Complicates feeding as baby cant compress against palate
Have to use soft bottle
Palate doesn’t get closed until 12 months as not possible to close before then as babies are obligate nasal breathers and closing the palate will result in swelling which can block the nose preventing breathing
What is the MDT for CLP
- Cleft nurse
- Surgeon
- Speech therapist
- Dental team
- ENT respiratory
- Geneticist
- Psychologist
Who is in the CLP dental team
paediatric dentist
dental therapist
restorative dentist
oral surgeon
orthodontist
orthodontic therapist
What is the pre-surgical orthopaedics done
strapping
done to bring segments together prior to cleft repair
What is the expansion/extraction/bone grafting
Bone graft assessment (7-8 years old, OPT) want the canines half formed as this allows for fastest movement
Done at around 8-9 years old as risk of damage to underlying teeth
Alveolar region left until 8-9
Put bone (taken from hip) in the cleft region and it is important that teeth come through it within 3 years otherwise we will lose the teeth
What are the 3 things to consider when doing definitive orthodontics for these patients
bone graft
growth
aesthetics
What are the bone graft considerations
o Did it work and is there bone to move the teeth around
What are the growth considerations
o How are they going to grow
o Class 3 growth means delaying the correction of the incisor relationship
o Good growers - don’t end up with class 3
o Poor growers - end up with class 3. Line teeth up but leave them in class 3
o Borderline growers. Line up dentition
What are the dental aesthetic considerations prior to ortho
o Cant open spaces where the bone graft is as it will disappear
o Is there hypodontia
o Are teeth hypoplastic
o Lip line is often low on the side of the cleft so easier camoglauge
What is the patient journey timeline
- 3 months - lip closure
- 6-12 months - palate closure (want palate normal asap for better speech development)
- 8-10 years - alveolar bone graft
- 12-15 years - definitive orthodontics
- 18-20 years - surgery
