CLP

Question 1

use a word to describe the aetiology of CLP

Answer 1

multifactorial

Question 2

what type tends to have a dental impact?

Answer 2

CLP

Question 3

what does CP tend to affect rather than dental?

Answer 3

speech

Question 4

what is the commonest craniofacial abnormality?

Answer 4

CLP

Question 5

classification

Answer 5

LAHSHAL - letter for each aspect that the cleft involves

Question 6

what % are unilateral?

Answer 6

80%

Question 7

what % are bilateral?

Answer 7

20%

Question 8

prevalence

Answer 8

1:700 live births

Question 9

what % are sporadic?

Answer 9

70%

Question 10

aetiology

Answer 10

genetic - syndromes, FH, sex ratio, laterality, ethnic distribution
env - social deprivation, smoking, alcohol, anti epileptics, multivitamins

Question 11

implications

Answer 11

aesthetics
speech
dental (if through alveolus)
hearing
airway
other anomalies

Question 12

implications - speech

Answer 12

sound production or articulation problem
levator veli palatini - prevents air escaping through nose when you speak as soft palate against pharynx
- if not functioning properly get hypernasality

Question 13

implications - hearing

Answer 13

face forms from brachial arches (1st and 2nd)
- on the outside have pouches and clefts - creates ears
if cleft involves a craniofacial structure there is a good chance it will affect your hearing
also pressure in middle ear doesn’t get equalised so more prone to infections

Question 14

implications - airway

Answer 14

small jaws - tongue falls back

Question 15

implications - other anomalies

Answer 15

syndromes e.g. Aperts (issue with mid-facial growth)

cardiac issues

Question 16

cleft team

Answer 16

cleft nurse
surgeon
speech therapist
dental team
ENT
respiratory
geneticist
psychologist

Question 17

pt journey stages

Answer 17

lip closure
palate closure
alveolar bone graft
definitive orthodontics
surgery

Question 18

lip closure

Answer 18

around 3m

stronger to cope with GA

Question 19

palate closure

Answer 19

around 6-12m

start to babble around 12m so make palate as normal as possible by then

Question 20

alveolar bone graft age

Answer 20

around 8-10 years

Question 21

definitive ortho

Answer 21

around 12-15 years

often slightly slower at getting teeth through

Question 22

surgery age

Answer 22

around 18-20years

Question 23

when can nasal surgery be done from?

Answer 23

15 years - nasal growth completed

Question 24

how do the clinics correspond to tx stages?

Answer 24

baby MDT - newborn
children's clinic - 0-7 years
bone graft clinic - 7-12 years
transition clinic 12-16years
adult clinic 16+ years

Question 25

dental issues

Answer 25

missing teeth
impacted teeth
crowding
growth
caries

Question 26

dental issues - missing teeth and caries

Answer 26

most commonly lateral incisor

link to caries - social deprivation, dental anomalies

Question 27

dental issues - impacted teeth

Answer 27

supernumeraries

can affect other teeth erupting - problem as bone graft will disappear if no teeth

Question 28

dental issues - crowding

Answer 28

usually U arch
scarring on palate - narrow maxilla
don’t tend to grow forwards - small maxilla

Question 29

dental issues - growth

Answer 29

maxilla doesn't tend to grow well
often develop into a class 3 occlusion

Question 30

dental cleft team

Answer 30

paediatric dentist
dental therapist
orthodontist
orthodontic therapist
restorative dentist
oral surgeon

Question 31

orthodontic tx stages

Answer 31

pre-surgical orthopaedics
expansion/bone grafting
definitive orthodontics
orthognathic surgery

Question 32

pre-surgical orthopaedics

Answer 32

not v common now
strapping
dento-alveolar moulding (pre-surgical ortho plate)
no evidence they work

Question 33

pre-surgical orthopaedics - strapping

Answer 33

try to reduce gap between cleft segments
should make surgery easier as less scarring
Dyna cleft - tension on lip and palate

Question 34

pre-surgical orthopaedics - dento-alveolar moulding (pre-surgical ortho plate)

Answer 34

theories
- if you cover palate with plate it is easier to suckle and feed
- tongue wouldn’t sit high up so segments would come together
but have to take imps - <6m obligate nasal breathers
- alginate blocks their nose - asphyxiation
- try to suckle alginate - down palate

Question 35

why is expansion/bone grafting needed?

Answer 35

you have closed the lip and palate but still have hole across alveolus
teeth want to erupt
purpose is to allow the teeth to erupt into the arch so you can do ortho

Question 36

timing of expansion/bone grafting

Answer 36

want 3 to erupt into bone graft site to maintain the bone
around 9 years - timed around canine
take radiograph 7years to see what is developing around the cleft site

Question 37

when would you usually remove any supernumeraries?

Answer 37

about 3m before bone grafting/expansion surgery

Question 38

why would you have braces before expansion/bone grafting surgery?

Answer 38

only if access to the cleft site for the surgeon is difficult

historically was routinely done

Question 39

expansion/bone grafting surgical technique

Answer 39

bone from hip (similar) - cancellous bone so good blood supply
flaps - need to use attached mucosa otherwise teeth wont erupt through it

Question 40

when would you radiograph after expansion/bone grafting and why?

Answer 40

6m to ensure bone there

Question 41

what does definitive ortho tx depend on?

Answer 41

bone graft - need roots in the bone graft to maintain it
aesthetics
growth - often grow class 3
 - pt may be happy leaving with slight class 3 incisors?

Question 42

how does aesthetics affect definitive ortho tx?

Answer 42

teeth often narrow
missing lateral incisor
central incisor hypoplastic and small
lip line often lower
aesthetics of nose tend to be more obvious than teeth

Question 43

why can orthognathic surgery be difficult?

Answer 43

lack of bone
tooth position
issue - if move jaw forward can make it hard for soft palate to hit pharynx
- hypernasality esp if had issues before surgery

Question 44

lip surgery

Answer 44

Abbe flap to improve aesthetics of U lip