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
0.14%

Question 9

what % are sporadic?

Answer 9

70%

Question 10

aetiology

Answer 10

genetic -

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

environmental

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

Question 11

what syndrome is assoc with CLP

Answer 11

• Van der Woude
• Treacher Collins
• Apert
• Crouzon

Question 12

sex ratio

Answer 12

M>F
(6:4)

Question 13

which type is more common

Answer 13

CP > CL > UCLP > BCLP

Question 14

implications

Answer 14

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

Question 15

implications - speech

Answer 15

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

Question 16

implications - hearing

Answer 16

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

Question 17

implications - airway

Answer 17

small jaws - tongue falls back

Question 18

implications - other anomalies

Answer 18

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

Question 19

cleft team

Answer 19

cleft nurse
surgeon
speech therapist
dental team
ENT
respiratory
geneticist
psychologist

Question 20

pt journey stages UCLP

Answer 20

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

first 3 compulsory

Question 21

lip closure

Answer 21

around 3m

stronger to cope with GA

Question 22

palate closure

Answer 22

around 6-12m

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

Question 23

alveolar bone graft age

Answer 23

around 8-10 years

Question 24

definitive ortho

Answer 24

around 12-15 years

often slightly slower at getting teeth through

Question 25

surgery age

Answer 25

around 18-20years

Question 26

when can nasal surgery be done from?

Answer 26

15 years - nasal growth completed

Question 27

how do the clinics correspond to tx stages?

Answer 27

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

Question 28

dental issues

Answer 28

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

Question 29

Most common missing teeth

Answer 29

lateral incisor

Question 30

dental issue -caries

Answer 30

due to hyperplastic teeth

Question 31

dental issues - impacted teeth reason

Answer 31

supernumeraries

Question 32

dental issues - crowding

Answer 32

- usually U arch - problam of relapse

Question 33

dental issues - growth

Answer 33

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

Question 34

dental cleft team

Answer 34

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

Question 35

orthodontic tx stages

Answer 35

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

Question 36

pre-surgical orthopaedics

Answer 36

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

Question 37

pre-surgical orthopaedics - strapping

Answer 37

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

Question 38

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

Answer 38

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 39

why is expansion/bone grafting needed?

Answer 39

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 40

timing of expansion/bone grafting

Answer 40

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

Question 41

when would you usually remove any supernumeraries?

Answer 41

about 3m before bone grafting/expansion surgery

Question 42

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

Answer 42

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

Question 43

expansion/bone grafting surgical technique

Answer 43

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

Question 44

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

Answer 44

6m to ensure bone there

Question 45

what does definitive ortho tx depend on?

Answer 45

``` 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 46

how does aesthetics affect definitive ortho tx?

Answer 46

``` 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 47

why can orthognathic surgery be difficult?

Answer 47

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