Teeth abnormalities, TMD, cleft lip, surgery Flashcards Preview

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Flashcards in Teeth abnormalities, TMD, cleft lip, surgery Deck (24)
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Indications for orthognathic surgery

- severe jaw discrepancies
- anterior open that is causing problems
- speech, eating or functional problems
- asymmetry
- psychological issues
- depending on age and if still growing (need to not be growing)
- need good OH and IOTN 4/5


Risks of orthognathic surgery

normal surgery risks
failure to achieve results
nerve damage/numb lower lip


contraindications to orthognathic surgery

BMI >30
Bleeding problems
Severe mental health issues
small condyles/TMJ problems increase risk of relapse


Steps to orthognathic surgery

1. Joint clinic and facial planning
2. Pre-surgery ortho (2yrs)
3. Surgery
4. Post-surgery ortho (6months)


What information is needed in the facial planning stage of orthognathic surgery

Radiographs, impressions, perio and dental assessment
what is the patient's concern/problems
Measurements e.g. face height and how much they deviate from normal - use a Ceph for side profile.


What is involved in pre-orthoganthic surgery orthodontics

1. Extractions
2. Remove dental compensation (anterior teeth)
3. close gaps and align teeth
4. coordinate arch widths
5. level the arches
6. place rigid fixation wires


What is involved in post-orthoganthic surgery orthodontics

Elastics and fixed wires used to close the gaps between the arches and secure everything in place in the new ICP.


Different orthognathic surgery techniques

- Bilateral sagittal split osteotomy
- Le Fort 1 osteotomy
- surgically assisted rapid maxillary expansion SARME
- Genioplasty


what is the risk of numbness to the lower lip after orthognathic surgery

30-40% permanent


How is cleft lip/palate caused

lack of mesenchyme or failure to fuse in vitro


Cleft lip and palate aetiology

Genetic - 40% FH
Environmental - nutritional deficiency, anaemia, alcohol, obesity,


What is a subcutaneous cleft palate/signs

translucent/blue area, bifid uvula - where the mucosa is normal but overlying a cleft palate


Most common cleft/lip palate presentations

50% Cleft lip and palate
30% Cleft palate
20% Cleft lip


Syndromes/disorders associated with cleft lip/palate

Van der Woude
Pierre Robin
Foetal alcohol spectrum


Pierre robin syndrome

Floppy tongue, mandibular retrognathia, cleft palate. Can be associated with Sickler syndrome. Difficulties eating and breathing.


Stickler syndrome

Connective tissue disorder causing cardiac and retinal problems


Van der Woude syndrome

Cardiac problems, cleft palate, invaginations in lip, hypodontia


Foetal alcohol spectrum disorder

small head, low body weight, learning difficulties, coordination problems, cleft lip and palate


Neonatal cleft lip/palate management inc surgery details

Special bottle for feeding that doesn't rely on suckling
Wait until babies are thriving and then surgery for cleft lip (3 months) and cleft palate (6 months).
Cleft lip - make muscles lie horizontally like lip
Cleft palate - nasal epithelium, muscles and oral epithelium closure (3 layers)
Alveolar defect not fixed
Remove any neonatal teeth


Young cleft lip/palate children management

Class 3 incisors due to previous surgery
Dental anomalies - missing teeth, displaced/ectopic teeth, microform teeth, fused teeth, hypoplastic enamel
Poor OH - painful surgery sites, fistulas so poor diet, altered saliva, tongue movement
Speech therapy and hearing therapy


Speech therapy for cleft lip/palate patients

Nasal speech because of fistulas
Can't pronounce T sounds etc bc tongue avoids the roof of the palate where surgery was
For all patients


Hearing tests for cleft lip/palate patients

Can get glue ear if the defect affects the middle ear draining through the eustachian tube. May need to place a tube to drain ear or child can grow out of it w age.


Cleft lip/palate older children management

9-11 years old, fix alveolar defects with grafts to close fistulas, align maxilla so teeth can erupt normally.
Unfavourable skeletal growth e.g. class 3 can affect options- may need orthognathic surgery but need to consider previous surgeries, scars and effects on speech.
Any gaps that can't be fixed with bone grafts may need to be accepted or use restorative dentistry to improve aesthetics.


GDP considerations when managing cleft lip/palate patients

- High caries risk
- Limited access
- Multiple appointments with other health care professions/other syndromes and complex MH