Cleft Lip and Palate

Question 1

what is the jxn between lip and palate?

Answer 1

incisive foramen

Question 2

T/F: cleft lip is always anterior

Answer 2

true

Question 3

T/F: cleft palate is always posterior

Answer 3

false, may be anterior or posterior or both

Question 4

class I Veau cleft of LIP

Answer 4

unilateral notching of the vermillion border, not extending into lip (microform)

Question 5

class II Veau cleft of LIP

Answer 5

unilateral cleft extending into lip (incomplete)

Question 6

class III Veau cleft of LIP

Answer 6

unilateral cleft involving the floor of the nose (complete)

Question 7

class IV Veau cleft of LIP

Answer 7

any bilateral cleft of the lip

Question 8

class I Veau cleft of PALATE

Answer 8

isolated soft palate cleft only

Question 9

class II Veau cleft of PALATE

Answer 9

unilateral soft and hard palate cleft

Question 10

class III Veau cleft of PALATE

Answer 10

unilateral cleft involving soft/hard palate thorugh the alveolus (usually involves lip too)

Question 11

class IV Veau cleft of PALATE

Answer 11

same as class II but BILATERAL

Question 12

what causes cleft lip?

Answer 12

caused by partial or complete lack of fusion of maxillary prominence with the medial nasal prominence

Question 13

what causes cleft palate?

Answer 13

lack of fusion of the palatine shelves

Question 14

what are some reasons why palatine shelves didn’t fuse?

Answer 14

1. smallness of shelves
2. failure of shelves to elevate
3. inhibition of shelf fusion
4. failure of tongue dropping (micrognathia)

Question 15

etiology of cleft lip palate

Answer 15

1. environmental
2. genetic
3. mixed of environmental and genetic

Question 16

environmental causes of cleft lip palate

Answer 16

1. maternal smoking
2. teratogens (i.e. EtOH, anticonvulsants)
3. maternal obesity, nutrition, infection, hyperthermia, exposure to ionizing radiation (suspected)

Question 17

genes that cause cleft lip palate

Answer 17

1. IRF6
2. 8q24 locus
3. VAX1

Question 18

cause of isolated (non-syndromic) cleft lip palate

Answer 18

multifactorial, environmental and genetic factors but known teratogens as well

Question 19

chromosomal anomalies that cause Syndromic Cleft Lip +/- Palate

Answer 19

1. trisomy 13 (Patau)
2. 18 (Edwards)
3. 21 (Downs)
4. 22q11 deletion syndrome (velocardiofacial)

Question 20

inherited syndromes that cause Syndromic Cleft Lip +/- Palate

Answer 20

1. Sticklers (AD)
2. Treacher Collins (AD)
3. Van de Woude (AD)

Question 21

non-inherited syndromes that cause Syndromic Cleft Lip +/- Palate

Answer 21

Pierre Robin Sequence

Question 22

how many CLP cases are associated with syndromes?

Answer 22

1/3rd

Question 23

how many syndromes have CLP as a primary feature?

Answer 23

over 400 (1/2 due to Mendelian inheritance)

Question 24

list the order of races that has the highest to least number of incidence of CLP

Answer 24

American Indian/Asian > Caucasian > African descent

Question 25

cleft lip is more frequent in which sex?

Answer 25

males

Question 26

isolated cleft palate is more frequent in which sex?

Answer 26

females

Question 27

surgeries for CLP

Answer 27

1. lip adhesion: 1-2 months 2. lip repair: ~3-4 months 3. palate repair: ~8-12 months 4. tympanostomy tubes: 1-6 years 5. posterior pharyngeal flap: 6-18 years 6. alveolar bone graft: ~10 years 7. orthognathic surgery 8. alveolar grafting/block grafts 9. dental implants

Question 28

pre-lip repair care

Answer 28

1. dynacleft taping 2. nasoalveolar molding appliance (NAM) 3. lip adhesion surgery

Question 29

lip adhesion surgery reduces what?

Answer 29

tension on final scar after definitive repair

Question 30

why is alveolar bone grafting indicated?

Answer 30

clefts through the alveolar ridge, may have residual oronasal fistula and bony defect through the ridge, nose and palate

Question 31

T/F: alveolar bone grafting may be required even after successful lip and palate repair

Answer 31

true

Question 32

T/F: children with CLP are at a higher risk for caries

Answer 32

true

Question 33

in what area are caries higher in CLP pts?

Answer 33

max anterior regions and bilateral clefting

Question 34

T/F: children with CLP have good OH

Answer 34

false, poor

Question 35

T/F: children with CLP have perio disease and progression is faster than general population

Answer 35

true

Question 36

T/F: CLP care REQUIRES coordination fro ma large multidisciplinary team

Answer 36

true