Ortho Tx Of Cleft Lip/Palate Flashcards
T/F: clefts of the lip and the palate are the most common of facial/oral congenital anomalies
True
Cleft lip and/or palate occurs in
1 in 700 births
~4300 newborns per year
Overall ratio male:female cleft lip/palate
3:2
Clefts of the palate ONLY female: male ratio
2:1
Incidence of CL/CP
Cleft lip and palate =40%
Cleft palate= 32%
Cleft lip = 28%
Whites of European decent incidence of CL/CP
1 in 700 live births
T/F: older woman have a lower incidence of giving birth to a CL/CP child
False- higher
Over the age 35 doubles risk
Over age 39 triples risk
Group 1
Clefts of lip only
Group 2
Clefts of the secondary palate only
Group 3
Clefts of the lip, alveolus and palate
Complete cleft lip and palate
Group 4
Clefts of the lip and alveolus
Primary cleft palate and lip
Group 5
Miscellaneous group
Includes cleft which do not fit into the above categories
Classification of CL/CP
Unilateral incomplete
Unilateral complete
Bilateral complete
Cleft lip embryology
Failure of max process and medial nasal process to fuse
Fusion generally happens at week 6
May affect both lip and primary palate
What does MNP give rise to
4 permanent incisors
Cleft palate embryology
Failure of the palate shelves to meet and fuse
Fusion begins at week 7-8 and completed by week 10
Etiology of CL/CP
Syndromic
Familial
Isolated or non familial
Syndromic
Chromosomal, single gene, mitochondrial disorders
Environmental etiologies
~1% cases
Familial
2 or more affected individuals in first, second and third degree relatives
~25 % of cases
Isolated or non-familial
First person pedigree to have defect
~75% cases
Complicates associated with CL/CP
Bonding issues
Feeding difficulties
Ear infections and hearing loss
Speech and language delays
Dental problems
Psychosocial problems
Tx of CL/CP
Surgical/non surgical stages - birth to young adulthood
Craniofacial team
Surgical tx staging
Social worker
Nurse team coordinator
Genetic counselor
Audiologist
Otolaryngologist
Speech and language specialist
Pediatric dentist
Ortho
Pediatrician
Plastic/craniofacial surgeon
First surgical intervention - primary lip closure
May need orthopedic force to proximate the primary palate prior to initial surgery
Expansion may be necessary
Rule of 10 applied
Rule of 10
10 weeks
10 pounds
10 mg hemoglobin
Second surgical intervention
12-18 months of age
Close hard and soft
Speech development major concern
Pharyngeal flap surgery
Control airflow to imporve speech
Velopharyngeal inadequacy resulting in hypernasality
Age 4
Ortho intervention
Prepare cleft side receive bone graft
Timing - eruption of perm canine (1/3 root formed)
Have permanent canine erupt through bone graft - spontaneous, expose and pull in if not
Donor sites - bone graft
Alveolar
Iliac crest
Cranial
Braces are used to align the ____
Incisors
Lateral is adjacent to cleft generally missing
What class skeletal pattern do pts typically have
Class 3 maxillary deificient
Comp ortho with or without surgery to address