Clinical aspects of cleft lip and palate

Study Notes

Cleft Lip and Palate: Clinical Aspects

Cleft lip and palate is the most common craniofacial malformation, accounting for 65% of all abnormalities affecting the head and neck.
Cleft lip and palate arises due to the failure of fusion during the two stages of dentofacial development.
The development of the secondary palate (hard and soft) involves the palatal shelves.
The tongue lowers, and the shelves elevate towards the midline, typically occurring between the 7th and 8th weeks of intrauterine life.
Failure of the tongue to drop, fusion of the shelves, or a breakdown in the fusion process can lead to cleft palate.
Failure of the shelves to fuse results in cleft lip and/or alveolus.

Classification of Cleft Lip and Palate

Primary palate clefts occur in front of the incisive foramen.
Complete cleft palate directly communicates with the nasal cavity.
Incomplete cleft palate involves a partial separation of the palate.
Unilateral cleft lip affects one side of the lip.
Bilateral cleft lip affects both sides.

Treatment of Cleft Lip and Palate

Ante-natal care focuses on informing and counseling the parents about the condition.
Postnatal care includes multidisciplinary management, involving plastic surgeons, orthodontists, speech therapists, and pediatricians.
Pre-surgical orthodontics involves using appliances to:
- Align the alveolar segments
- Improve arch form and coordination
- Create space for bone grafts
- Facilitate lip closure
- Prevent further skeletal discrepancies

Orthodontic Implications of Cleft Lip and Palate

Alveolar bone defects
Skeletal discrepancies
Dental anomalies
Narrow maxillary arch
Crossbite
Malocclusion
Supernumerary teeth
Missing teeth
Hypoplastic teeth
Ectopic teeth
Delayed eruption
Increased risk of periodontal disease
Speech difficulties

Clinical Aspects of Cleft Lip and Palate

Cleft lip and palate is the most common craniofacial malformation, accounting for 65% of all head and neck abnormalities.
Cleft lip and palate are caused by a failure of fusion during the two stages of dentofacial development.
The development of the secondary palate (hard and soft) involves the palatal shelves elevating towards the midline as the tongue lowers.
This process occurs during the 7th and 8th weeks of intrauterine life.
A failure of the tongue to drop, fusion of the shelves, or a breakdown of the joint can lead to a cleft palate.
Incomplete fusion results in a cleft lip and/or alveolus.
Cleft lip and palate are considered polygenic inheritance, meaning they are caused by multiple genes.
A complete cleft palate communicates directly with the nasal cavity.
An incomplete cleft palate does not communicate with the nasal cavity.
A cleft lip can be unilateral or bilateral.
Cleft lip and palate can be classified into primary and secondary palates based on the location of the cleft.
The primary palate is located in front of the incisive foramen.
Prenatal care for cleft lip and palate includes genetic counseling, advising the parents of the implications of surgery, and providing support during gestation.
Postnatal care involves managing feeding difficulties, providing support to the parents, and coordinating treatment with other healthcare professionals.
Pre-surgical orthodontics aim to improve feeding, facilitate speech, and prepare the palate for surgery.
Pre-surgical orthodontics involves the use of appliances such as a palatal obturator, a nasoalveolar molding device, and a removable appliance with a palatal prosthesis.
Pre-surgical orthodontics can also help correct the position of the tongue and maxillary arch.
Cleft lip and palate can have significant orthodontic implications, impacting the growth and development of the dentition, alveolar bone, and facial structures.
These individuals are often impacted by crowding, missing teeth, malocclusion issues, and problems with tooth eruption.