Cleft lip and palate

Question 1

what is the primary palate?

Answer 1

lip, alveolus, and palate anterior to incisive foramen

Question 2

what is the secondary palate?

Answer 2

soft and hard palate up to incisive foramen

Question 3

what are the types of clefts that can occur in the primary palate?

Answer 3

unilateral - complete/incomplete

bilateral - complete/incomplete

Question 4

what are the types of clefts that occur in the secondary palate?

Answer 4

complete
incomplete
submucous

Question 5

what are the types of clefts of the primary and secondary palates?

Answer 5

unilateral - complete/incomplete

bilateral - complete/incomplete

Question 6

what race is CLP more common in?

what side of the face is more commonly affected?

Answer 6

caucasians

left

Question 7

how does CLP occur?

Answer 7

isolated deformity or part of a syndrome
genetic reasons
environmental reasons

Question 8

what genetically causes a CLP to occur?

Answer 8

short palatal shelves

Question 9

what environmental factors can cause a baby to be born with CLP?

Answer 9

maternal alcohol and smoking
anticonvulsant or steroid therapy
folic acid deficiency

Question 10

if there is a family history of CL with or without palatal involvement what are the risks to the child?

Answer 10

40% risk of offspring having it

2nd child 1 in 20 chance

Question 11

if there is a family history of CP what are the risks for the child?

Answer 11

20% risk of offspring having it

lesser genetic component - risk of 1in 80 of further offspring being affected

Question 12

when does the development of the face/upper lip begin?

Answer 12

5th and 9th week i.u

Question 13

what is the lip formed from?

Answer 13

fusing of maxillary processes

Question 14

how is the palate formed and when is it formed?

Answer 14

palate is formed from the palatal processes of maxillary processes - 6-11th week i.u

Question 15

what begins at 7th wee i.u?

Answer 15

tooth development

Question 16

what may clefts cause in dental development?

Answer 16

duplication of tooth types, malformed roots and crowns, enamel hypoplasia, absence/ectopic teeth

Question 17

what problems can CLP cause to a baby?

Answer 17

feeding/hearing/speech/emotional/dental

Question 18

why is feeding a problem in babies with CLP?

Answer 18

cannot create a negative intra oral pressure

- haeberman feeder can fix

Question 19

why is hearing a problem with CLP?`

Answer 19

problems with middle ear ventilation of eustacian tube

surgery of palate can impede tube function

Question 20

why do CLP cause problems with speech?

Answer 20

affected by fistula
or soft palate not being able to make contact with pharynx
secondary to poor hearing

Question 21

what is electropaltalography?

Answer 21

URA with electrodes

Question 22

what procedure can be done at 3 months?

Answer 22

lip repair

Question 23

what procedure can be done at 6-12 months?

Answer 23

palate repair

Question 24

what can be done between 8 and a half and 10 years?

Answer 24

expansion/ alveolar bone graft

Question 25

what treatment will need done when CLP baby enters the permanent dentition?

Answer 25

ortho orthagnathic surgery plastic surgery

Question 26

what are pre surgery orthopaedics?

Answer 26

URA - stop tongue sitting in cleft - encourages shelf growth aids feeding approximates cleft segments

Question 27

what is lip strapping used for?

Answer 27

controls growth of pre maxilla = facilitates lip closure

Question 28

how is a lip repair done?

Answer 28

muscles of lip and alar are dissected out and re opposed minimal to reduce scarring if palate is cleft it can be defect is corrected at same time

Question 29

how is palate repair done?

Answer 29

6-12 months oral and nasal cavities are seperated mobilisation of tissues laterally and displaced across the midline to cover the cleft

Question 30

what is Cleftsis?

Answer 30

care until 16years asses at 9-12 months, 2-5 years, 7-15yrs aim to maintain primary and secondary teeth and encourage good dental care

Question 31

what problems may arise in the mixed dentition as a result of a CLP?

Answer 31

``` delayed eruption hypodontia reduction of tooth size abnormalities of tooth size and shape enamel defects ortho probs ```

Question 32

what ortho tx is needed in CLP?

Answer 32

presurgical orthopaedics in birth align max dentition obturators, palatal lift and EPG appliances

Question 33

before alveolar bone grafting what needs to be done?

Answer 33

XLA any deciduous/SN teeth in the cleft FA to align max/mandib teeth FA to align skeletal discrepancy for orthagnathic surgery

Question 34

when does alv bone grafting occur?

Answer 34

between 8 and a half and ten years - canine roots are a half to two thirds formed

Question 35

what does allowing the canine to erupt into the graft do?

Answer 35

fuses the maxilla, provides alar base support

Question 36

what bone is used for a graft?

Answer 36

cancellous bone from iliac crest, tibia or cranium

Question 37

what is plastic surgery used to treat?

Answer 37

improves nasal aesthetics lip revision close residual palatal fistulae

Question 38

why might a rhinoplasty be needed after orthagnathic surgery?

Answer 38

underlying bone can affect the contour of the nose