Cleft Lip and Palate: Craniofacial Malformation

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Questions and Answers

What percentage of all anomalies affecting the head and neck does cleft lip and palate comprise of?

40%

70%

65% (correct)

50%

What is the prevalence of cleft lip and palate among Caucasians?

1 in every 1500 live births

1 in every 1000 live births

1 in every 700 live births (correct)

1 in every 500 live births

At what week of intra-uterine life does the fusion of the maxillary and medial nasal processes occur?

10th week

8th week

4th week

6th week (correct)

What percentage of cases of cleft lip have a family history?

40% Signup and view all the answers

What is the term for the process by which the palatal shelves change from a vertical to a horizontal position?

Flip-up Signup and view all the answers

What is the term for the palate that forms after the fusion of the maxillary and medial nasal processes?

Secondary palate Signup and view all the answers

What is the proportion of cases of cleft lip with or without cleft palate that have a family history?

2:1 Signup and view all the answers

What are the three main features affected by cleft lip and/or palate?

Feeding, Hearing, Speech Signup and view all the answers

What percentage of CLP patients require orthognathic surgery?

25 per cent Signup and view all the answers

At what stage should prosthetic replacement be carried out?

After growth has been completed Signup and view all the answers

What is the primary focus of management in CLP?

Auditing treatment progress Signup and view all the answers

What is the current state of management of CLP in Egypt?

Decentralised care with varying techniques Signup and view all the answers

What is the importance of standardised records in CLP management?

All of the above Signup and view all the answers

What is the typical duration of CLP management?

From birth to mid-twenties Signup and view all the answers

What is the primary benefit of concentration of expertise and experience in CLP management?

Improved patient outcomes Signup and view all the answers

What is the most common craniofacial malformation affecting the head and neck?

Cleft lip and palate Signup and view all the answers

What is the primary responsibility of the specialized nurse in the management of cleft babies?

Educating the mother for feeding the cleft babies Signup and view all the answers

At what age is surgical repair of cleft lip usually carried out?

Between 3 and 6 months of age Signup and view all the answers

What is the purpose of nasal stents in the management of cleft babies?

To improve alar support Signup and view all the answers

What is the average age for pharyngeal surgery in the management of cleft babies?

Between 4-5 years of age Signup and view all the answers

What is the primary goal of presurgical orthopaedic alignment in the management of cleft babies?

To reduce the size of the cleft defect Signup and view all the answers

At what age does speech assessment typically start in the management of cleft babies?

By the age of 2 years Signup and view all the answers

What is the term used to describe the process of adding nasal stents to improve alar support?

Naso-alveolar molding Signup and view all the answers

Why is the closure of the hard palate sometimes delayed until 5 years of age in some European centres?

To reduce the restriction effects of early surgery upon growth Signup and view all the answers

What is a potential problem associated with velopharyngeal insufficiency?

Speech development delay Signup and view all the answers

What is a common dental anomaly associated with cleft lip and palate?

Hypodontia, especially the maxillary lateral incisor Signup and view all the answers

What is the effect of surgical repair of a cleft lip and palate on facial growth?

Marked restriction of mid-face growth antero-posteriorly Signup and view all the answers

What is the prevalence of other congenital abnormalities in individuals with cleft lip and palate?

Greater in babies with isolated cleft palate Signup and view all the answers

What is the effect of velopharyngeal insufficiency on the Eustachian tube?

It predisposes to hearing difficulties Signup and view all the answers

What is a characteristic of the dental arch in unilateral cleft lip and palate?

Segmentation into greater and lesser segments Signup and view all the answers

What is the effect of cleft lip only on speech development?

It has minimal effect on speech development Signup and view all the answers

What is a potential problem associated with feeding difficulties in individuals with cleft lip and palate?

Poor weight gain due to inadequate nutritional intake Signup and view all the answers

What is the primary purpose of alveolar or secondary bone grafting in the mixed dentition stage?

To provide an intact arch and improved alar base support Signup and view all the answers

At what age is the bone grafting procedure usually carried out?

Around 8–10 years of age Signup and view all the answers

What is the purpose of orthodontic treatment prior to graft placement?

To expand the collapsed maxillary arch and create surgical access Signup and view all the answers

What type of appliance is often used to expand the maxillary arch prior to graft placement?

W arch or a quadhelix appliance Signup and view all the answers

What is the primary focus of orthodontic treatment during the permanent dentition stage?

To align the maxillary incisors Signup and view all the answers

What is the purpose of using a facemask with maxillary expansion plate?

To correct the skeletal Class III relationship Signup and view all the answers

Why is care taken not to move any teeth into the cleft site during orthodontic treatment?

Because there is no bone in the cleft site Signup and view all the answers

What is the result of the restraining effect of surgery upon growth during the mixed dentition stage?

More apparent transverse and antero-posterior growth Signup and view all the answers

Study Notes

Cleft Lip and Palate (CLP)

Cleft lip and palate is the most common craniofacial malformation, accounting for 65% of all anomalies affecting the head and neck.
The prevalence of CLP varies geographically and between different racial groups, occurring in approximately 1 in every 700 live births among Caucasians (0.42/1000 live births).

Developmental Process

In normal development, fusion of the maxillary and medial nasal processes occurs around the sixth week of intra-uterine life.
The palatal shelves 'flip-up' from a vertical to a horizontal position, followed by fusion to form the secondary palate, around the eighth week.
The embryological processes must grow until they come into contact before fusion can take place.

Feeding and Nutrition

Feeding difficulties are associated with fatigue, poor weight gain, excessive air intake, and nasal regurgitation.
Feeding problems depend on the type and severity of the cleft and whether both lip and palate are involved.

Speech and Hearing

Velopharyngeal insufficiency affects speech development, as the soft palate is unable to make adequate contact with the back of the pharynx to close off the nasal airway.
A cleft involving the posterior part of the hard and soft palate can cause hearing difficulties, which can also retard speech development.
Cleft lip only is usually associated with minimal problems.

Dental and Orthodontic Issues

Unilateral cleft lip and palate is associated with segmentation of the dental arch into lesser and greater segments.
Bilateral clefts involve both lateral segments, often collapsed behind a prominent premaxilla.
Delayed eruption, hypodontia, microdontia, and enamel defects are common dental anomalies.
Individuals with unoperated clefts do not experience a significant restriction of facial growth.

Management and Treatment

Management is a long-term, complex, multidisciplinary process that starts from birth and extends to over 20 years of age.
The clinical nurse provides initial support and advice, and educates the mother on feeding the cleft baby.
Presurgical orthopaedic alignment of the cleft alveolar segments may be carried out in the neonate.
Surgical repair of cleft lip is usually carried out between 3 and 6 months of age, and cleft palate repair between 6-9 months or 9-12 months of age.
Speech assessment starts by the age of 2 years, and pharyngeal surgery may be needed to improve velo-pharyngeal insufficiency.
Alveolar or secondary bone grafting is performed around 8-10 years of age, before the eruption of the permanent canine.
A period of orthodontic treatment is required prior to graft placement, followed by a period of retention.
Orthognathic surgery may be required in 25% of CLP patients, and prosthetic replacement may be needed to replace missing teeth.

Importance of Multidisciplinary Care

The most important thing in management of CLP is being able to audit the treatment progress among the different disciplines involved in care provision.
Concentration of expertise and experience at certain centres of excellence produces superior results to those obtained by discrete practitioners.
Standardised treatment protocols for management of CLP have been set in many countries, and careful standardised records should be taken before and after any intervention.
Patients' registration systems are still lacking in most centres, and initiatives for establishment of a standardised national protocol have been taken to achieve a more efficient care of cleft patients.

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Description

This quiz covers the basics of cleft lip and palate, including its definition, prevalence, and geographic variations. Learn about the common craniofacial malformation and its effects on physical and developmental anomalies.