Ortho Tx Of Cleft Lip/Palate

Question 1

T/F: clefts of the lip and the palate are the most common of facial/oral congenital anomalies

Answer 1

True

Question 2

Cleft lip and/or palate occurs in

Answer 2

1 in 700 births
~4300 newborns per year

Question 3

Overall ratio male:female cleft lip/palate

Answer 3

3:2

Question 4

Clefts of the palate ONLY female: male ratio

Answer 4

2:1

Question 5

Incidence of CL/CP

Answer 5

Cleft lip and palate =40%
Cleft palate= 32%
Cleft lip = 28%

Question 6

Whites of European decent incidence of CL/CP

Answer 6

1 in 700 live births

Question 7

T/F: older woman have a lower incidence of giving birth to a CL/CP child

Answer 7

False- higher
Over the age 35 doubles risk
Over age 39 triples risk

Question 8

Group 1

Answer 8

Clefts of lip only

Question 9

Group 2

Answer 9

Clefts of the secondary palate only

Question 10

Group 3

Answer 10

Clefts of the lip, alveolus and palate
Complete cleft lip and palate

Question 11

Group 4

Answer 11

Clefts of the lip and alveolus
Primary cleft palate and lip

Question 12

Group 5

Answer 12

Miscellaneous group
Includes cleft which do not fit into the above categories

Question 13

Classification of CL/CP

Answer 13

Unilateral incomplete
Unilateral complete
Bilateral complete

Question 14

Cleft lip embryology

Answer 14

Failure of max process and medial nasal process to fuse
Fusion generally happens at week 6
May affect both lip and primary palate

Question 15

What does MNP give rise to

Answer 15

4 permanent incisors

Question 16

Cleft palate embryology

Answer 16

Failure of the palate shelves to meet and fuse
Fusion begins at week 7-8 and completed by week 10

Question 17

Etiology of CL/CP

Answer 17

Syndromic
Familial
Isolated or non familial

Question 18

Syndromic

Answer 18

Chromosomal, single gene, mitochondrial disorders
Environmental etiologies
~1% cases

Question 19

Familial

Answer 19

2 or more affected individuals in first, second and third degree relatives
~25 % of cases

Question 20

Isolated or non-familial

Answer 20

First person pedigree to have defect
~75% cases

Question 21

Complicates associated with CL/CP

Answer 21

Bonding issues
Feeding difficulties
Ear infections and hearing loss
Speech and language delays
Dental problems
Psychosocial problems

Question 22

Tx of CL/CP

Answer 22

Surgical/non surgical stages - birth to young adulthood
Craniofacial team

Question 23

Surgical tx staging

Answer 23

Social worker
Nurse team coordinator
Genetic counselor
Audiologist
Otolaryngologist
Speech and language specialist
Pediatric dentist
Ortho
Pediatrician
Plastic/craniofacial surgeon

Question 24

First surgical intervention - primary lip closure

Answer 24

May need orthopedic force to proximate the primary palate prior to initial surgery
Expansion may be necessary
Rule of 10 applied

Question 25

Rule of 10

Answer 25

10 weeks 10 pounds 10 mg hemoglobin

Question 26

Second surgical intervention

Answer 26

12-18 months of age Close hard and soft Speech development major concern

Question 27

Pharyngeal flap surgery

Answer 27

Control airflow to imporve speech Velopharyngeal inadequacy resulting in hypernasality Age 4

Question 28

Ortho intervention

Answer 28

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

Question 29

Donor sites - bone graft

Answer 29

Alveolar Iliac crest Cranial

Question 30

Braces are used to align the ____

Answer 30

Incisors Lateral is adjacent to cleft generally missing

Question 31

What class skeletal pattern do pts typically have

Answer 31

Class 3 maxillary deificient Comp ortho with or without surgery to address