Cleft Palate Flashcards
1
Q
Define Cleft lip and palate
A
- Most common cranio-facial abnormality in human.
- 1 in 700 live births in UK
- CP often associated with syndromes
2
Q
Incidence
A
- Unilateral CLP - 25%
- CP - 50%
- bilateral CLP - 10%
- CL - 10%
- Submucosa cleft 5%
3
Q
Sex distribution Incidence
A
- Unilateral CLP male : female 2:1
- CP male : female 2:3
- CL male : female 2:1
4
Q
Racial bias incidence
A
- Japanese > Caucasian > Afro Caribbean
- Unilateral clefts more common on left - L:R 2:1
- 15% cleft associated with other syndromes
5
Q
CP is 15% associated Other syndromes like?
A
- Sticklers
- Van der Woudes
- Pierre Robin Sequence
- Downs
- Di George/ 22 q
6
Q
Aetiology of CLP
A
- Unknown , Polygenic and multifactorial.
- Genetics - few single genes known e.g IRF 6 mutation leading to Van der woude syndrome. CL OR PALATE with lower lip pitting.
- Environmental e.g. Retinoids, anti folate drugs, temperature, hypoxia , seasonal, maternal smoking ( first trimester) , diet , Vitamin B6 deficiency .
7
Q
Genetic risks
A
- Unaffected parents with 1 effected child:
Risk of next child being affected : CLP 1:25(4%) CP 1:80. - 1 affected parent :
Risk of first child being affected : CLP 1:50 (2%). - 1 affected parent and child :
Risk of second child being affected: CLP 1:10 (10%) - 2 affected parents
Risk of first child being affected: CLP 3:5 (60%)
8
Q
CSAG - Clinical standard advisory group 1998
A
- 57 centres 50% operating <5 Clefts a year
- Outcome was poor , re organised
- managed clinical network
- South wales and south west
- Bristol and Swansea
- 100 new births per years
9
Q
Overall care - Team Approach
Management involve many specialties.
A
- Corrective Surgery ( Plastics, OMFS - Oral maxillofacial surgeon.
- Speech (SLT)
- Hearing ( Audiologist, ENT)
- Dental ( Paediatric, Orthodontic, Restorative).
- Psychological
10
Q
Prenatal diagnosis
A
- CL can be detected with ultrasound scanning but the palate is more difficult to detect.
- Due to head position and small size of the face not usually reliable until at least week 15 IU.
11
Q
Time scale.
A
- 3/12 months Lip repair
- 6-9/12 palate repair
- 5 yrs Audit records
- 8-11 yrs Alveolar Bone graft
- 10 Audit records
- 15 Audit records
- 20 Audit records
12
Q
Classification
A
- There are many e.g. Veau, Kernahan and Stark but it is easier to describe cleft.
- A - No cleft
- B - Celft lip
- C- unilateral complete Cleft lip and palate
- D- Bilateral Complete cleft lip and palate
- E- Cleft palate
13
Q
Children with born with cleft palate have many problems which may include:
A
- Feeding- Cannot suckle because negative intra - Oral pressure cannot be created)
- hearing
- Speech
- Disruption of facial growth.
- Disruption of dental development
- Dental anomalies
- Dental caries
- Psychosocial
- morbidity and mortality associated with treatment
14
Q
Feeding -
A
- Contact within 24hours
- Specialist nursing
- breast feeding rarely possible
- Use special soft bottle
- Sympathetic support
- Haberman - soft bottle
15
Q
Dental issue
A
- Hypodontia
- Supernumaries
- Hypoplasia
- Microdontia
- Delayed eruption of teeth on cleft side
- increased incidence of ectopic canine.
- Increased incidence of impacted 6.
- Increased incidence of crossbite (19%).
- Dental caries - GDP preventative treatment is essential and should start in first year of life.
