Cleft Lip and Palate

Question 1

How are cleft lip and palate caused?

Answer 1

Due to interaction between crania-facial and embryological processes

Likely due to issue w/ volume or failure of flow of mesenchyme = failure to fuse

Question 2

What is cleft lip and palate?

Answer 2

Failure of fusion

Question 3

How chart cleft lip and palate?

Answer 3

LAHSHAL
Dental charting - right to left
Lip, alveolus, hard palate, soft palate, hard palate, alveolus, lip

Question 4

Difference LAHSHAL and lahshal?

Answer 4

lower case denote incomplete

upper case complete cleft

Question 5

How denote left hand side complete cleft affecting lip, alveolus, hard palate and soft palate?

Answer 5

….SHAL

Question 6

How chart complete bilateral cleft?

Answer 6

LAHSHAL

Question 7

How chart incomplete cleft lip?

Answer 7

Depends on side

l…..

Question 8

What are incomplete cleft lip referred to as?

Answer 8

Forme Fustra

Question 9

How to incomplete cleft lip present?

Answer 9

Defect vermillion border and minor degree asymmetry of nose

Question 10

What is often cause of incomplete cleft lip?

Answer 10

Lack of failure rather lack mesenchyme

Question 11

How to chart isolated cleft palate?

Answer 11

..HSH../…S….

Question 12

Issue w/ isolated palatal clefts?

Answer 12

Speech

Question 13

How do sub-mucosal cleft palate present clinically?

Answer 13

Bifid uvula
Blue translucent zone
Abnormal muscle insertion

Question 14

What hx may see in sub-mucosal palatal cleft?

Answer 14

Hx of problems feeding

Question 15

How common is CL&P

Answer 15

1 in 650 births

Question 16

Aetiology of CL&P

Answer 16

Genetic
Environment
Likely genetic triggered by environment

Question 17

What are environmental factors in CL&P

Answer 17

Anti-convulsant drug, nutritional defect, anaemia

Smoking, alcohol, obesity

Question 18

Diagnosis of CLP?

Answer 18

Ante natal scan - around 20-40 weeks

Screening offered to all women

Question 19

What feature of ante-natal scan may increase suspicion?

Answer 19

Incorrect naso-labial angle

Question 20

What happens if suspicion CLP on scan?

Answer 20

Have 3D scan - extent of cleft lip - hard know palate involved

Question 21

What happens if child dx w/ cleft lip before birth?

Answer 21

Family seen before birth and within 24 hours of birth

Question 22

Why are babies visited cleft service within 24 hr birth?

Answer 22

Help issue w/ breathing/ feeding

Check co-morbidities

Question 23

What are 3 syndromes associated w/ CP?

Answer 23

Van de Woude
Pierre Robin sequence
Foetal Alcohol Spectrum Disorder

Question 24

What see in Van de Woude?

Answer 24

Lip pits
Hypodontia
Cardiac abnormalities
CP

Question 25

What see in Pierre Robin sequence?

Answer 25

CP | Mandibular retrognathia - head to chest during foetal growth

Question 26

Issue w/ mandibular retrognathia in Pierre Robin?

Answer 26

Small jaw - issue maintaining airway and issue w/ feeding

Question 27

What see is FASD?

Answer 27

Small head, low body weight, learning diff, co-ordination issue

Question 28

When are cleft lip and palate repaired?

Answer 28

When baby thriving - good circulating volume

Question 29

When can cleft lip be repaired?

Answer 29

From 3 month

Question 30

When can cleft palate be repaired?

Answer 30

From 6 month

Question 31

What impact on growth can be seen following CLP surgery?

Answer 31

Development class II

Question 32

What should do with neonatal teeth?

Answer 32

Removal w/ topical LA if impede feeding/ risk inhalation | If not XLA time CLP repair

Question 33

What abnormality can see in pt w/ CLP?

Answer 33

Neonatal teeth

Question 34

Why is there neonatal teethn in CLP?

Answer 34

Disruption dental lamina

Question 35

Common dental abnormalities in CLP?

Answer 35

Class III incisor - inhibition maxillary development Hypoplastic enamel Displaced teeth at cleft site

Question 36

Dental consideration CLP?

Answer 36

OH and dental advice | Hypoplastic enamel - prone plaque build up

Question 37

Why CLP pt higher risk of caries?

Answer 37

Diet - cariogenic, communication makes hard to eat some foods OH - limited access, reluctance brush near site Reduced salivary flow Access care

Question 38

Preventative advice for CLP?

Answer 38

``` Water night F- toothpaste Diet advice Preserve primary teeth - maintain space Referral specialist ```

Question 39

What can also be issue in CLP pt?

Answer 39

Speech and hearing

Question 40

What do all CLP pt receive?

Answer 40

Speech therapy

Question 41

What ear issues do CLP pt suffer from?

Answer 41

Glue ear - issue drainage from Eustachian tube (linked palatal movement) - less issue as older and tube become more vertical

Question 42

What age is alveolar bone grafting considered?

Answer 42

Age 9-11

Question 43

Aim of alveolar bone grafting?

Answer 43

Address bony alveolar deficit Aims encourage eruption maxillary canine Close oronasal fistula

Question 44

What do to if CLP pt has adverse facial growth?

Answer 44

Orthognathic referral

Question 45

What age are CLP pt seen up to?

Answer 45

20 years

Question 46

What may older CLP pt complain of ?

Answer 46

Nasal drip Food nose Unhappy appearance

Question 47

What team provides cleft care?

Answer 47

MDT