Cleft Lip / Palate Flashcards
What is the main purposes for Bone Grafting in CLP?
Bone grafting in the MIXED dentition in the residual ALVEOLAR cleft:
- Stabilization of the maxillary arch
- Facilitation of eruption of the canine and sometimes facilitation of the lateral incisor eruption
- Providing bony support to the teeth adjacent to the cleft
- Raising the alar base of the nose.
- facilitation of closure of an oro-nasal fistula
- Making it possible to insert a titanium fixture in the grafted site
- Obtain favourable periodontal conditions of the teeth within and adjacent to the cleft.
When is the best timing for Bone Graft in CLP?
Take into consideration not only eruption of the CANINE but also that of the LATERAL incisor, if present.
The best time for bone grafting surgery is when a thin shell of BONE STILL COVERS the soon erupting lateral incisor or canine tooth close to the cleft.
Cleft Nose 👃 is different how?
Horizontal Nostril
Alar is more horizontal
Columella is shorter
Structures involved in the formation of Cleft LIP?
🕧
Medial Nasal Process and Maxillary Process
6 WEEKS 🕧
What is prevelance for both Cleft Lip and Cleft Palate?
Cleft Lip - 1:700 births
Cleft Palate - 1:1000 births
Most common DENTAL ANOMALY in Cleft Palate involving Alveolar Ridge?
CONGENITAL ABSENT LATERAL INCISOR
Missing teeth were observed in 66.7% of patients, with maxillary LATERAL incisor as the most frequently affected tooth.
Supernumerary teeth were observed in 16.7% of patients
What are associated issues in patients with CLP?
- Feeding issues - difficulty latching
- Airway issues - deficient Mandible
- Hearing issues - Eustachian Tube dysfunction
- Velopharyngeal Insufficiency - nasal air emits during speech
- Speech Issues - Hypernasal Speech
- Psychological issues - due to facial differences
Hypenasal speech is caused by?
Velopharyngeal insufficiency
- Disorder of structure that causes a failure of the VELUM (SOFT PALATE) to close against the posterior pharyngeal wall (back wall of the throat) during speech in order to close off the nose (nasal cavity) during oral speech production.
- Largely a function of the ratio between pharyngeal depth to palatal length.
- associated with Cleft Palate AND Submucosal Cleft Palate.
What is the prevalence of ulilateral vs bilateral cleft lip / palate
U3X>B
Unilateral CLP was the most common cleft type and seen more on the left side.
Unilateral clefts of both the primary and secondary palates were found to occur over three times more frequently than bilateral clefts, and left side predominance was demonstrated.
U3X>B
While males were affected more by CLP, isolated CP was seen more in females than in males.
Cleft Lip affect on the Nasal Alar
The typical nose of cleft lip nasal deformity can be summarized as having an asymmetrical, flat dorsum, broad tip, and wide alar base on the cleft side
The orbicularis oris inserts in a discontinuous manner into the COLUMELLA on the noncleft side. This creates an unopposed force that pulls the columella and caudal nasal SEPTUM to the NONCLEFT side.
On the cleft side, the orbicularis inserts into the nasal base, retracting it laterally and inferiorly. Additionally, due to poor maxillary skeletal support at the alar base, the ala is further displaced posteriorly. The horizontally oriented wide nostril on the cleft side is one of the major stigmas of the cleft lip-associated nasal deformity.
When do Palatal shelves fuse in utero?
9-11 WEEKS
The development of the secondary palate commences in the sixth week of human embryonic development. It is characterised by the formation of two palatal shelves on the maxillary prominences, the elevation of these shelves to a horizontal position, and then a process of palatal fusion between the horizontal shelves.
Complete Cleft Lip / Palate is missing….
Mid-Palatal Suture
When does surgical repair for Cleft Lip occur?
3-6 months
Most kids with Cleft Lip / Palate have?
Underlying Syndrome
What determines timing of Alveolar bone graft for Cleft Palate?
Facial Growth
