Cleft lip & palate

Question 1

What is oro-facial clefting

Answer 1

• 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

Question 2

What is the kernahan and stark classification

Answer 2

o Cleft lip - either cleft lip (CL) or clift lip and palate (CLP)
o Cleft palate - cleft palate (CP)

Question 3

What is LAHSHAL

Answer 3

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

Question 4

What does it mean if the letter is not capital in LAHSHAL

Answer 4

this means that the cleft is not complete

Question 5

What is the incidence of CLP

Answer 5

1:700

Question 6

What is the gender distribution

Answer 6

cleft lip with or without palate more common in males
cleft palate more common in female

Question 7

Which is more common, CL or CLP

Answer 7

same in Scotland

Question 8

What can the aetiology be split into

Answer 8

genetic
environmental

Question 9

What can genetic aetiology be split into

Answer 9

syndromes
family history
sex ratio
laterality
ethnic distribution

Question 10

What are the environmental factors in the aetiology

Answer 10

o Social deprivation
o Smoking
o Alcohol
o Anti-epileptics
o multivitamins

top 3 important

Question 11

What are the implications of cleft lip and palate

Answer 11

aesthetics
speech
dental
hearing
other

Question 12

When is the lip repaired

Answer 12

3-6 months

Question 13

What is the impact on CLP on speech

Answer 13

Hyper nasal
Palate important in pronounciation of certain sounds: p and ph

Question 14

What are the impacts of hypodontia on dental features

Answer 14

hypodontia
impacted teeth
crowding
growth
caries

Question 15

How does CLP result in hypodontia

Answer 15

In area associated with cleft
Teeth near cleft may be small and hyperplastic

Question 16

How does CLP result in impacted teeth

Answer 16

Can be prone to supernumerary teeth which can stop the teeth from coming through

Question 17

How does CLP result in crowding

Answer 17

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

Question 18

How does CLP effect growth

Answer 18

 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

Question 19

How does CLP result in caries

Answer 19

 Low socioeconomic background = higher risk
 Teeth hyperplastic etc so increases caries risk level

Question 20

What ear problems are CLP prone to

Answer 20

o More prone to glue ear
o More prone to hearing problems

Question 21

What other problems do CLP px face

Answer 21

cardiac
feeding when babies

Question 22

How does CLP cause feeding issues

Answer 22

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

Question 23

What is the MDT for CLP

Answer 23

• Cleft nurse
• Surgeon
• Speech therapist
• Dental team
• ENT respiratory
• Geneticist
• Psychologist

Question 24

Who is in the CLP dental team

Answer 24

paediatric dentist
dental therapist
restorative dentist
oral surgeon
orthodontist
orthodontic therapist

Question 25

What is the pre-surgical orthopaedics done

Answer 25

strapping
done to bring segments together prior to cleft repair

Question 26

What is the expansion/extraction/bone grafting

Answer 26

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

Question 27

What are the 3 things to consider when doing definitive orthodontics for these patients

Answer 27

bone graft
growth
aesthetics

Question 28

What are the bone graft considerations

Answer 28

o Did it work and is there bone to move the teeth around

Question 29

What are the growth considerations

Answer 29

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

Question 30

What are the dental aesthetic considerations prior to ortho

Answer 30

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

Question 31

What is the patient journey timeline

Answer 31

• 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