Cleft Lip and Palate

Question 1

risk factors for cleft lip and palate

Answer 1

maternal use of teratogens (anticonvulsants and retinoic acid)
maternal smoking and alcohol ingestion
folic acid deficiency

Question 2

genetic status with higher incidence of clap

Answer 2

both normal, 2 affected children

one parent affected, 1 child affected

Question 3

formation of the lips and nose starts at ___ weeks and ends at __ weeks

direction of the fusion is ___

Answer 3

starts at 5 weeks, ends at 10 weeks

direction: superior to inferior

Question 4

what is a cleft lip

Answer 4

• orbicularis oris inserts into the floor of the nose instead of forming a complete ring

Question 5

t/f a patient can have a cleft nose with an intact lip

Answer 5

false, superior to inferior fusion leads to formation of intact floor of nose with cleft of the lip

Question 6

complete vs incomplete cleft lip

Answer 6

complete: affects the entire lip and extends up to the nose (problem is around 5th week)
incomplete: nose is already formed, only a portion of the lip is affected (problem 8-9th week)

Question 7

formation of the palate starts at __ weeks and ends at __ weeks

direction of the fusion is __

Answer 7

starts at 7 weeks, ends at 10 weeks

direction is anterior to posterior

Question 8

what is a cleft palate

Answer 8

• muscles of the soft palate insert on the posterior portion of the hard palate instead of interdigitating at the palatine aponeurosis (midline)

Question 9

t/f you can have a patient with an intact soft palate, but cleft hard palate

Answer 9

false, the direction of the closure is ant-post. a patient can have an intact hard palate, but cleft soft palate

Question 10

complete vs incomplete cleft palate

Answer 10

complete: problem at 7th week
incomplete: problem at 8-9th week

Question 11

what does LAHSHAL stand for

Answer 11

lip right
alveolar ridge right
hard palate right
soft palate
hard palate left
alveolar ridge left
lip left

Question 12

clap grading

Answer 12

1 = 1/3 cleft
2 = 2/3 cleft
3 - complete cleft

Question 13

thallwitz lip grading

Answer 13

L/L0 no defect
L1 notch up to the vermillion
L2 between L1 and L3
L3 up to the nost

Question 14

thallwitz alveolar ridge grading

Answer 14

A/A0 no defect
A1 involves the alveolar ridge but not the pre-maxilla
A2 involved pre-maxilla anterior to incisive foramen
A3 reaches the incisive foramen

Question 15

thallwitz hard palate grading

Answer 15

H/H0 no defect
H1 notch from the maxillary tuberosity or 3rd molar
H2 reaches 2/3 of the way to the incisive foramen
H3 reaches the incisive foramen

Question 16

thallwitz soft palate grading

Answer 16

S/S0 no defect

S3 entire soft palate until maxillary tuberosity or 3rd molar (hard palate cleft = always S3)

Question 17

associated problems with clap

Answer 17

• feeding (cannot generate negative pressure, food goes up the nose)
• speech
• dental problems
• otologic-OME or AOM (due to soft palate cleft)
• psychological

Question 18

affected muscle that causes OME or AOM

Answer 18

tensor veli platini muscle

Question 19

device that can assisst the feeding of patient with clap

Answer 19

feeding plate or obturator

Question 20

roles of feeding obturator

Answer 20

• helps in closing palatal/ alveolar defect
  separates oral and nasal cavity at the area of the HARD PALATE
• generates negative pressure
• increased weight
• aids in breathing and speech

Question 21

t/f feeding obturators can be used in isolated cleft lip or isolated soft palate defects

Answer 21

false, soft palate cannot be obturated because baby will not ba able to breathe due to lack of mobility of soft palate. gag reflex will be stimulated

Question 22

what is cheiloplasty

Answer 22

• repair of cleft lip
• for improvement of feeding
• prevents widening of alveolar cleft

Question 23

timing of cheiloplasty

Answer 23

rule of tens: 10(-12) weeks of age, 10 pounds, hemoglobin 10 g

Question 24

what is palatoplasty

Answer 24

• repair of the clefts of the hard and soft palate
• separates oral and nasal cavity
• constructs watertight velopharynx or soft palate
• development of aesthetic dentition
• functional occlusion
• preservation of facial growth

Question 25

timing of palatoplasy

Answer 25

• 12 mos but before 2 yo
• too early: interferes with facial growth
• loo late: leasd to speech impairment