CLP Flashcards
use a word to describe the aetiology of CLP
multifactorial
what type tends to have a dental impact?
CLP
what does CP tend to affect rather than dental?
speech
what is the commonest craniofacial abnormality?
CLP
classification
LAHSHAL - letter for each aspect that the cleft involves
what % are unilateral?
80%
what % are bilateral?
20%
prevalence
1:700 live births
what % are sporadic?
70%
aetiology
genetic - syndromes, FH, sex ratio, laterality, ethnic distribution
env - social deprivation, smoking, alcohol, anti epileptics, multivitamins
implications
aesthetics speech dental (if through alveolus) hearing airway other anomalies
implications - speech
sound production or articulation problem
levator veli palatini - prevents air escaping through nose when you speak as soft palate against pharynx
- if not functioning properly get hypernasality
implications - hearing
face forms from brachial arches (1st and 2nd)
- on the outside have pouches and clefts - creates ears
if cleft involves a craniofacial structure there is a good chance it will affect your hearing
also pressure in middle ear doesn’t get equalised so more prone to infections
implications - airway
small jaws - tongue falls back
implications - other anomalies
syndromes e.g. Aperts (issue with mid-facial growth)
cardiac issues
cleft team
cleft nurse surgeon speech therapist dental team ENT respiratory geneticist psychologist
pt journey stages
lip closure palate closure alveolar bone graft definitive orthodontics surgery
lip closure
around 3m
stronger to cope with GA
palate closure
around 6-12m
start to babble around 12m so make palate as normal as possible by then
alveolar bone graft age
around 8-10 years
definitive ortho
around 12-15 years
often slightly slower at getting teeth through
surgery age
around 18-20years
when can nasal surgery be done from?
15 years - nasal growth completed
how do the clinics correspond to tx stages?
baby MDT - newborn children's clinic - 0-7 years bone graft clinic - 7-12 years transition clinic 12-16years adult clinic 16+ years
dental issues
missing teeth impacted teeth crowding growth caries
dental issues - missing teeth and caries
most commonly lateral incisor
link to caries - social deprivation, dental anomalies
dental issues - impacted teeth
supernumeraries
can affect other teeth erupting - problem as bone graft will disappear if no teeth
dental issues - crowding
usually U arch
scarring on palate - narrow maxilla
don’t tend to grow forwards - small maxilla
dental issues - growth
maxilla doesn't tend to grow well often develop into a class 3 occlusion
dental cleft team
paediatric dentist dental therapist orthodontist orthodontic therapist restorative dentist oral surgeon
orthodontic tx stages
pre-surgical orthopaedics
expansion/bone grafting
definitive orthodontics
orthognathic surgery
pre-surgical orthopaedics
not v common now
strapping
dento-alveolar moulding (pre-surgical ortho plate)
no evidence they work
pre-surgical orthopaedics - strapping
try to reduce gap between cleft segments
should make surgery easier as less scarring
Dyna cleft - tension on lip and palate
pre-surgical orthopaedics - dento-alveolar moulding (pre-surgical ortho plate)
theories
- if you cover palate with plate it is easier to suckle and feed
- tongue wouldn’t sit high up so segments would come together
but have to take imps - <6m obligate nasal breathers
- alginate blocks their nose - asphyxiation
- try to suckle alginate - down palate
why is expansion/bone grafting needed?
you have closed the lip and palate but still have hole across alveolus
teeth want to erupt
purpose is to allow the teeth to erupt into the arch so you can do ortho
timing of expansion/bone grafting
want 3 to erupt into bone graft site to maintain the bone
around 9 years - timed around canine
take radiograph 7years to see what is developing around the cleft site
when would you usually remove any supernumeraries?
about 3m before bone grafting/expansion surgery
why would you have braces before expansion/bone grafting surgery?
only if access to the cleft site for the surgeon is difficult
historically was routinely done
expansion/bone grafting surgical technique
bone from hip (similar) - cancellous bone so good blood supply
flaps - need to use attached mucosa otherwise teeth wont erupt through it
when would you radiograph after expansion/bone grafting and why?
6m to ensure bone there
what does definitive ortho tx depend on?
bone graft - need roots in the bone graft to maintain it aesthetics growth - often grow class 3 - pt may be happy leaving with slight class 3 incisors?
how does aesthetics affect definitive ortho tx?
teeth often narrow missing lateral incisor central incisor hypoplastic and small lip line often lower aesthetics of nose tend to be more obvious than teeth
why can orthognathic surgery be difficult?
lack of bone
tooth position
issue - if move jaw forward can make it hard for soft palate to hit pharynx
- hypernasality esp if had issues before surgery
lip surgery
Abbe flap to improve aesthetics of U lip
