genetic - - syndromes, - FH, - sex ratio, - laterality ( left> right) - ethnic distribution environmental - social deprivation, - smoking, - alcohol, - anti epileptics, - nutrition deficiency (vit B & folic acid)

CLP Flashcards by L T

use a word to describe the aetiology of CLP

multifactorial

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what type tends to have a dental impact?

CLP

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what does CP tend to affect rather than dental?

speech

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what is the commonest craniofacial abnormality?

CLP

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classification

LAHSHAL - letter for each aspect that the cleft involves

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what % are unilateral?

80%

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what % are bilateral?

20%

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prevalence

1:700 live births
0.14%

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what % are sporadic?

70%

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aetiology

genetic -

syndromes,
FH,
sex ratio,
laterality ( left> right)
ethnic distribution

environmental

social deprivation,
smoking,
alcohol,
anti epileptics,
nutrition deficiency (vit B & folic acid)

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what syndrome is assoc with CLP

Van der Woude
Treacher Collins
Apert
Crouzon

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sex ratio

M>F
(6:4)

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which type is more common

CP > CL > UCLP > BCLP

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implications

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

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implications - speech

sound production or articulation problem
levator veli palatini - prevents air escaping through nose when you speak as soft palate against pharynx
- resulting in hypernasality

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implications - hearing

face forms from brachial arches (1st and 2nd)

ears forms from BA as well
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

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implications - airway

small jaws - tongue falls back

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implications - other anomalies

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

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cleft team

cleft nurse
surgeon
speech therapist
dental team
ENT
respiratory
geneticist
psychologist

pt journey stages UCLP

lip closure - 3mo
palate closure - 6-12mo
alveolar bone graft - 8-10year
definitive orthodontics- 12-15 yr
surgery - 18-20yr

first 3 compulsory

lip closure

around 3m

stronger to cope with GA

palate closure

around 6-12m

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

alveolar bone graft age

around 8-10 years

definitive ortho

around 12-15 years

often slightly slower at getting teeth through

surgery age

around 18-20years

when can nasal surgery be done from?

15 years - nasal growth completed

how do the clinics correspond to tx stages?

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

dental issues

``` missing teeth impacted teeth crowding growth caries ```

Most common missing teeth

lateral incisor

dental issue -caries

due to hyperplastic teeth

dental issues - impacted teeth reason

supernumeraries

dental issues - crowding

- usually U arch - problam of relapse

dental issues - growth

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

dental cleft team

``` paediatric dentist dental therapist orthodontist orthodontic therapist restorative dentist oral surgeon ```

orthodontic tx stages

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

pre-surgical orthopaedics

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

pre-surgical orthopaedics - strapping

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

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

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

why is expansion/bone grafting needed?

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

timing of expansion/bone grafting

want **canine** 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

when would you usually remove any supernumeraries?

about 3m before bone grafting/expansion surgery

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

only if access to the cleft site for the surgeon is difficult historically was routinely done

expansion/bone grafting surgical technique

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

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

6m to ensure bone there

what does definitive ortho tx depend on?

``` 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? ```

how does aesthetics affect definitive ortho tx?

``` 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 ```

why can orthognathic surgery be difficult?

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