Ortho - CL(P) Flashcards
At what stage in utero does the palate begin to form?
6-10 weeks
where are the palatal shelves formed from?
the 2 maxillary prominences
what pharyngeal arch are the palatal shelves/maxillary prominences formed from?
1st
what forms the primitive premaxilla/the primary palate?
the inferior extension of the of the medial nasal processes
what forms the secondary palate?
the 2 palatal shelves from the maxillary processes
at what week in utero does the primary ad secondary palates fuse?
week 9
- by week 10 the nasal cavity and oral cavity are separate
What causes cleft lip?
failure of the maxillary prominence to fuse with the medial nasal process
on what side and i what sex is cleft lip most commonly found?
LHS
MALE - 3 males: 1 female
What causes cleft palate?
failure of the 2 palatal shelves to fuse In the midline
What sex is most likely to have cleft lip in isolation and why?
Isolated cleft palate more common in females this is suggested to be caused by the later elevation of the palatal shelf (M = week 7, F = week 8)
How do we classify Cleft lip and palate?
Describe how this classification system is used.
LAHSHAL classification:
Designate a letter for every structure the cleft goes through;
L = lip
A =alveolus
H = hard palate
S = Soft palate
Small letter instead of capital = not complete deformity
What percentage of clefts lip and palates are unilateral?
What percentage of clefts lip and palates are bilateral?
80% - unilateral
20% bilateral
How common is CL(P)?
1:700 live births
What is the main cause of CL(P)?
70% sporadic
List genetic causes of CL(P). (5)
- Syndromes
- Family history (if u have a child with a cleft = 5% chance of another child with cleft)
- Sex ration
- Laterality: more common on the left
- Ethnic distribution
List environmental causes of CL(P). (5)
3 main:
- Social deprivation: poor
- Smoking
- Alcohol excessively
- Anti-epileptics
- Multivitamins (vitamin A analogues)
what problems are associated with CL(P)? (6)
- Aesthetics
- Speech: Esp with palate involvement = hypernasal voice - air goes through the nose when speaking
- Dental
- Heading / airway
- Others e.g. cardiac abnormalities
- Suckling problems (nurses show parents how to combat this with a soft bottle)
How would you describe the way in which those with a cleft palate sound when talking, what causes this?
hypernasal voice - air goes through the nose when speaking
The cleft team is a multidisciplinary team, what disciplines are involved? (9)
- cleft nurse: will see parents within 24 hours
- surgeon
- speech therapist: to assess speech progression
- dental team
- ENT
- Audiologist
- Respiratory/airway consultant
- Geneticist
- Psychologist
What stage of cleft care is carried out at 3 months and why?
Lip closure
- to solve aesthetic/social concerns for parets
What stage of cleft care is carried out at 6-12 months and why?
why cant this be done earlier?
palate closure
- Corrected for when sound/Babble starts
Newborns obligate nasal breathers can’t close palate before 6 months
What stage of cleft care is carried out at 8-10 years and why?
alveolar bone graft
Have to ensure treatment of the cleft site is timed around the development of the teeth surrounding it so that the unerupted permanent teeth aren’t affected.
What stage of cleft care is carried out at 12-15 years?
Definitive orthodontics
What stage of cleft care is carried out at 18-20 years and why?
secondary surgeries e.g. orthognathic surgery
have to ensure growth has stopped
What are the dental issues associated with CL(P)? (5)
- Impacted teeth
- Missing teeth
- Crowding
- growth
- Caries
Describe how CL(P) causes problems with impaction. (2)
Lots of supernumeraries at cleft site = impacted permanent teeth as they cannot erupt
Maxilla small and compressed = crowded and impacted teeth as there is not enough space to erupt
Describe how CL(P) causes problems with missing teeth. (2)
what teeth are commonly missing?
Teeth associated with the cleft site are missing
commonly laterals
Teeth near the cleft = Small and hypoplastic
Describe how CL(P) causes problems with crowing of teeth. (2)
scarring from cleft repair = small maxilla
Social demographic of cleft = poorer areas and poor attenders with high caries rate = primary teeth XLA and permanent teeth erupt prematurely and drift etc
Describe how CL(P) causes problems with growth.
What growth pattern is commonly associated with CLP?
Class III growth tendency
- scarring of the maxilla prevents translation of top jaw forward
Describe how CL(P) causes problems with caries (4).
- poor socioeconomic status/social demograohic = poor attendance and high caries rate
- Hypoplastic teeth near cleft site = more susceptible to caries
- Teeth erupt in unusual locations = hard to clean
- Extra teeth = crowing and hard to clean
What dental team members are involved in CLP management? (6)
- Paediatric dentist
- Dental therapist
- Restorative
- Oral surgeon
- Orthodontist
- Orthodontic therapist
When does assessment for alveolar bone graft take place and why?
Assessment at age 7/8 (lip and palate already fixed however the alveolar region not touched until 7/8)
- Assessment delayed until 7/8 to prevent damage to the unerupted teeth
How do we ensure the timing of the alveolar bone graft is correct?
when is surgery indicated?
Based around an OPT taken at 7/8 years old
Graft is indicated at the cleft site once the teeth surrounding the area are 50% formed (root)
What must be considered before starting definitive orthodontics? (3)
success of the bone graft
Patient growth
Dental aesthetics
What are the orthodontic tx options for “good growers”? (2)
Space closure
or
Space opening
What are the orthodontic tx options for “poor growers”?
ortho to align the teeth in a class III relationship
What are the orthodontic tx options for “borderline growers”?
Align the dentition and then reassess
