CLP

Question 1

Prevalence

Answer 1

1 in 700
30 cases per year NI

Question 2

Different presentations

Answer 2

Lip only
Palate only
Complete unilateral
Complete bilateral
Submucous cleft

Question 3

Anatomical aspects

Answer 3

Presentations related to abnormal embryology
- can affect lip/alveolar process/hard palate/soft palate
- surgery can partially correct disrupted anatomy

Dental problems
- disruption of dental lamina - missing teeth and supernumerary teeth

Ortho problems
- problems with facial growth

Speech problems
- soft palate

Appearance
- lip, facial growth

Question 4

Intermaxillary segment

Answer 4

Deep part of the medial nasal prominence
Labial component –> philtrum of upper lip
Upper jaw component –> carries 4 incisor teeth
Palatal component –> primary palate

Question 5

Problems for CLP pts

Answer 5

Feeding
Speech development
Effects of surgery
Dental
Acceptance by peers
Multiple hospital visits

Question 6

CLP Early Problems

Answer 6

Feeding
Repair of lip
-rule of 10s

Question 7

Intermediate problems of CLP patients

Answer 7

palatal closure (12-18 months) to allow speech development
speech therapy and hearing testing - ENT
dental supervision and tx
family support and tx
alveolar cleft grafting - age 9 - 10

Question 8

Dental problems

Answer 8

growth restriction upper jaw
bone defect in alveolar process in cleft
disruption of dental lamina
- missing teeth eg., upper lateral incisors
- extra teeth
-malformed teeth
- delayed dental development

Question 9

Maxillary growth

Answer 9

Maxillary retrognathia (Class III skeletal)
- maxilla is underdeveloped
- surgical scarring and/or congenital aetiology

Growth restriction highly correlated with surgical technique: scarring, incisions and denuded bone

Can be corrected by surgical maxillary advancement

Question 10

Alveolar cleft grafting

Answer 10

Fill the bony defect
Allow eruption of the canine tooth
Close any oronasal fistula
Provide support for the alar base of the nose

Question 11

Pre-graft orthodontics

Answer 11

Restoration of the normal shape of the upper jaw
Usually involves transverse expansion of the upper jaw
Correction of upper incisors which are behind the bite
On average 6-8 months of tx with orthodontic appliances

Question 12

Final phase of orthodontics

Answer 12

Fixed orthodontic appliances 18-24 months
Extractions may be required
May need orthogathnic surgery if severe maxillary growth restriction
Replacement of missing teeth - bridges/dental implants