Cleft lip and palate

Question 1

what is the primary palate made up of?

Answer 1

lip
alveoulus
palate- anterior to incisive foramen

Question 2

what is the secondary palate made up of?

Answer 2

soft and hard palate up to the incisive foramen

Question 3

how can clefts of the primary palate be classified?

Answer 3

1- unilateral complete or incomplete

2- bilateral complete or incomplete

Question 4

how can clefts of the secondary palate be classified?

Answer 4

1- complete
2-incomplete
3- submucous

Question 5

how can clefts of the primary and secondary palate be classified?

Answer 5

unilateral or bilateral - complete or incomplete

Question 6

what is the incidence of both cleft lip and palate?

Answer 6

1 in 750

2:1 male:famale

Question 7

what is the incidence of just cleft lip?

Answer 7

1 in 2000

1:2 male: female

Question 8

what is the most common form of cleft?

Answer 8

isolated cleft lip

Question 9

what is the least coming for of cleft?

Answer 9

bilateral cleft lip and palate

Question 10

what syndromes may be associated with cleft lip and palate?

Answer 10

pierre robin
aperts
crouzons

Question 11

what are genetic causes of clefts?

Answer 11

shortened palatal shelves

Question 12

what environmental factors can contribute to clefts?

Answer 12

maternal alcohol
smoking
anticonvulsant drugs
folic acids deficiency
steroid therapy

Question 13

what is the risk for offspring if a parent is affected with cleft lip and palate?

Answer 13

40% incidence in offspring

Question 14

what is the risk for subsequent offspring if first child of unaffected partents has cleft?

Answer 14

1 in 20

Question 15

how does the genetic component differ between cleft lip and cleft lip and palate?

Answer 15

lesser genetic component in just cleft lip

Question 16

When does the development of the face and upper lip begin?

Answer 16

5-9 week IU

Question 17

how does the lip normally form?

Answer 17

maxillary processes fuse together

Question 18

how does the palate form?

Answer 18

palatal processes of the maxillary processes fuse 6-11th week IU

Question 19

when do tooth germs develop?

Answer 19

7th week IU

Question 20

what defects may appear in teeth where clefts are present?

Answer 20

duplication of tooth types
malformed roots/crowns
enamel hypoplasia
hypodontia
ectopic teeth

Question 21

what other problems may sufferers of clefts experience?

Answer 21

feeding problems
hearing difficulties
speech difficulties
emotional problems
dental anomolies

Question 22

Why may issues occur with feeding?

Answer 22

child may be unable to create adequate negative intra oral pressure
results in extended feeding times and reduced nutritional intake

Question 23

what device can help feeding in children with clefts?

Answer 23

haberman feeders

Question 24

Why are problems with hearing often associated?

Answer 24

problems can occur with middle ear ventilation or Eustachian tubes

Question 25

palatal surgery can also help what function?

Answer 25

Eustachian tube function

Question 26

How can speech be adversely affected?

Answer 26

fistulae or soft palate may not make contact with pharynx | poor speech often comes secondary to poor hearing

Question 27

what can aid speech?

Answer 27

SALT | Electropalatography EPG

Question 28

what order does specialist treatment come in?

Answer 28

birth- parental councilling and feeding advice 3 months- lip repair 6-12 months- palate repair SALT and ENT mixed dentition- preventative advice and ortho Ax 8.5-10 year- expansion and alveolar bone grafting permanent dentition- definitive ortho, orthognatic surgery and plastics

Question 29

what pre surgery orthopaedics can be carried out?

Answer 29

URA prevent tongue sitting in cleft encourages lateral palatal shelf growth aids feeding in infants

Question 30

describe lip repair surgery

Answer 30

carried out at 3 months | dissect and re oppose muscles of lip and alar base

Question 31

why is minimal dissection important in lip repair surgery?

Answer 31

so scarring is limited and growth not further limited

Question 32

describe palatal surgery

Answer 32

carried out 6-12 months | aims to separate nasal and oral cavity

Question 33

what issues may be seen in the mixed dentition?

Answer 33

``` delayed eruption hypodontia general smaller tooth size abnormalities in tooth size and shape enamel defects ```

Question 34

what role does orthodontics take re. clefts?

Answer 34

provision of pre surgery orthopaedics from 6 years- alignment of maxillary dentition and correction of cross bites provision of obturators

Question 35

what preparation should be taken prior to alveolar bone grafting

Answer 35

removal of any supernumeraries or decisuous teeth prior to surgery pre surgery expansion in maxillary segments allignement of upper anteriors with FA during expansion

Question 36

where is bone sourced for bone grafting?

Answer 36

cancellous bone is used iliac crest tibia cranial cancellous bone

Question 37

what definitive ortho should be carried out in permanent dentition?

Answer 37

FA if no skeletal discrepancies | if Skeletal discrepancy- orthagnatic surgery when growth has ceased

Question 38

what ortho surgery is commonly required?

Answer 38

maxilla is often required to be expanded due to inhibited growth