CLP

Question 0

What can be included in the aetiology of CLP?

Answer 0

Genetics
- syndromes
Environmental
- drugs, mediaction
- diseases
- nutrition
- teratogens
Howeve, there is no one cause

Question 1

What is e embryological cause of CLP?

Answer 1

Failure to beeakdown if the epithelial lining preventing the fusing of the mesoderm of the mandibular, maxillary, nasal processes.
Failure of lateral palatal shelves (ectodermally lined mesoderm) to merge (e.g. From excessive lateral growth of the head / tongue obstruction etc..)
A bifid uvula is an example of this occuring only posteriorly (a narrow miss…)

Question 2

How can CLP be classified?

Answer 2

Kernaham and stark 1958

1) Unilateral but incomplete cleft of lip - simplest. Only lip involved
2) complete cleft of hard and soft palate
3) complete cleft of lip and albeolar ridge
4) complete cleft of lip, alveolar ridge and hard and soft palate
5) complete bilateral cleft of lip and primary palate
6) complete cleft of primary and secondary palate

Question 3

What is the difference between primary ands econdary palate?

Answer 3

Primary palate - premaxilla, anterior part of nasal septum
- forms before secondary
- issues in formation will almost always affect secondary palate
Secondary palate

Question 4

What are problems involved with CLP?

Answer 4

Aesthetics
Function
- feeding
- swallowing
- dental (crossbites)
Otolaryngological - throat issues as the mouth is open to the nasal cavity which connects to the eustaschion tube. Ear infections.
Speech - lack of control of expired air
Psychological
Growth

Question 5

What are the implications of maxillary clefting?

Answer 5

Segmentation of the maxilla into a major and minor segment resulting in asymmetrical muscular activity which in turn pulls the segments into different positions. Surgical needs to be brought back together.

Question 6

How can clp be managed?

Answer 6

Surgery
- lip (occurs at young age, normally about 3 years. Basically when child is able to undergo GA) (however, the cupids bow cannot be rproduced surgically)
- palate ( not fixed until later as any surgical management of secondary palate may prevent lateral expansion of maxilla)
Speech
Dental (these patients are normally not too concerned about teeth and oral hygiene)
Orthodontic

Question 7

How can clp involving primary palate positioned labially ne managed?

Answer 7

Orthopaedically try to move the primary palate back where it should be.
Can use a cast to approximate the maxillary segments.

Question 8

What are the implications on speech in clp patients?

Answer 8

Reinstatement of soft palate function via surgery so that child has control of expulsiono of air
However, surgery can result in scaring of soft palate causing it to retract and reduce in size. Difficult to contact to posteriro. (Velopharyngeal incompetence). This means that some aur escapes hence still some speech difficulty with speech requiring an explosive expulsion of air.

Question 9

What are some dental anomalies associated with clp?

Answer 9

Displaced teeth - ectopia, impactions (normally canines)
Missing teeth (mostly upper laterals), supernumeries
Trasposition
Crossbites (impaction of maxilla)
Occlusal plane cants
Distorte sagittal relations 
Midlines and smile lines affected
Ugly gingival contours
Poor oral hygiene