Cleft Lip and Palate Treatment Quiz
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Questions and Answers

What is the recommended timeframe for starting NAM therapy?

  • At 3-6 months of age
  • At the mixed dentition stage
  • At 6-18 months of age
  • Within the first 2 weeks of birth (correct)

    • How does NAM therapy affect the alveolar bone?

  • It has no direct impact on the alveolar bone shape.
  • It makes the alveolar bone less triangular and more natural. (correct)
  • It helps close the cleft gap by itself.
  • It increases the triangular shape of the alveolar bone.

    • What is the primary role of lip massage and lip taping in NAM therapy?

  • To strengthen the muscles around the mouth.
  • To improve the appearance of the lip.
  • To help close the cleft gap by pushing skin over the alveolar bone. (correct)
  • To prevent the formation of scar tissue.

    • What is the typical duration of NAM therapy for a baby born with a bilateral cleft lip and palate?

    <p>4-5 months</p> Signup and view all the answers

    What is the primary advantage of NAM therapy in preparing for alveolar repair?

    <p>It facilitates tension - free gingival closure during surgery.</p> Signup and view all the answers

    What is the most common donor site for bone grafting in patients with cleft of the alveolar bone?

    <p>Iliac crest or calvarial bone</p> Signup and view all the answers

    When is bone grafting typically performed in patients with cleft of the alveolar bone?

    <p>At the mixed dentition stage.</p> Signup and view all the answers

    What is a significant concern regarding the growth patterns of patients with clefts?

    <p>Significant discrepancy between maxillary and mandibular growth patterns.</p> Signup and view all the answers

    What happens when the medial nasal prominences do not properly fuse with the maxillary and lateral nasal prominences?

    <p>It leads to clefting of the lip and palate.</p> Signup and view all the answers

    Which of the following is NOT a contributing factor to the formation of cleft lip and palate?

    <p>Infant hydration level</p> Signup and view all the answers

    What role does the tongue play in the closure of the secondary palate?

    <p>Removal of the tongue from between the palatal shelves is crucial.</p> Signup and view all the answers

    What is the result of interference with the forward movement of the lateral nasal process during primary palate formation?

    <p>Clefting of the lip or palate may occur.</p> Signup and view all the answers

    Which developmental stage is crucial for the mingling of the medial and lateral nasal prominences?

    <p>The breakdown of surface epithelia.</p> Signup and view all the answers

    What is a common goal of orthodontic treatment for patients with cleft lip and palate?

    <p>Creating a normal occlusion</p> Signup and view all the answers

    Which condition might necessitate complex orthodontic treatment?

    <p>Severe transverse maxillary deficiency</p> Signup and view all the answers

    What treatment is specifically indicated for severe hypoplastic maxillas?

    <p>Maxillary distraction osteogenesis</p> Signup and view all the answers

    What may be a feature in the dental presentation of cleft lip and palate patients?

    <p>V-shaped arch form with crowding</p> Signup and view all the answers

    Which surgical option may be considered in orthodontics for addressing severe cases of jaw misalignment?

    <p>Orthognathic surgery</p> Signup and view all the answers

    What is a possible cause of cleft lip and palate related to maternal health during pregnancy?

    <p>Folic acid deficiency</p> Signup and view all the answers

    Which group in the Veau classification specifically describes complete bilateral clefts?

    <p>Group IV</p> Signup and view all the answers

    What type of cleft refers specifically to an incomplete cleft of the soft palate and uvula?

    <p>Group I cleft in Veau classification</p> Signup and view all the answers

    Which type of cleft includes both the hard palate and soft palate in Davis and Ritchie's classification?

    <p>Group II</p> Signup and view all the answers

    What type of stress during pregnancy is associated with an increased risk of cleft lip and palate?

    <p>Physical and emotional stress</p> Signup and view all the answers

    In the context of cleft lip and palate, what distinguishes complete unilateral clefts from other types?

    <p>They specifically involve the lip and one side of the palate</p> Signup and view all the answers

    Identifying the types of clefts, which of the following describes a median cleft?

    <p>Cleft of the lip without hard palate involvement</p> Signup and view all the answers

    Which type of cleft represents an incomplete formation affecting the uvula?

    <p>Cleft uvula</p> Signup and view all the answers

    What is the occurrence rate of cleft lip, with or without palate, in births?

    <p>1 in 1000</p> Signup and view all the answers

    At what week of pregnancy does cleft lip typically occur?

    <p>6th week</p> Signup and view all the answers

    Which imaging technique can diagnose cleft lip and palate with up to 90% accuracy in the 2nd trimester?

    <p>3D Ultrasonography</p> Signup and view all the answers

    What potential psychological impact is mentioned for patients with cleft lip and palate?

    <p>Lower self-esteem</p> Signup and view all the answers

    What issue is commonly experienced by infants with cleft lip and palate during feeding?

    <p>Difficulty with feeding</p> Signup and view all the answers

    Which clinical manifestation is NOT associated with cleft lip and palate?

    <p>Improved articulation</p> Signup and view all the answers

    What is a potential dental defect seen in patients with a cleft lip and palate?

    <p>Missing or supernumerary teeth</p> Signup and view all the answers

    Which syndrome is NOT indicated as associated with cleft lip and palate?

    <p>Down syndrome</p> Signup and view all the answers

    Which of the following is NOT a common dental defect associated with cleft?

    <p>Delayed eruption of specific permanent teeth</p> Signup and view all the answers

    What does the term "hypoplasia" refer to in the context of dental defects associated with clefts?

    <p>A weakening or thinning of the dental enamel, making it more prone to damage.</p> Signup and view all the answers

    What is the primary purpose of Nasoalveolar Molding (NAM)?

    <p>To reshape the nasal alar cartilages and correct nasal deformities present at birth.</p> Signup and view all the answers

    How does the flexibility of the cartilaginous septum play a role in the effectiveness of NAM?

    <p>The flexibility allows for the septum to be easily manipulated and molded into the desired shape.</p> Signup and view all the answers

    Which of the following is a common dental concern associated with the eruption of permanent canines in individuals with clefts?

    <p>The canines may erupt in an ectopic position, meaning they emerge in an abnormal location.</p> Signup and view all the answers

    Why is there a strong emphasis on coordinating alveolar bone grafting with orthodontic treatment for patients with clefts?

    <p>To create a stable foundation for teeth movement and prevent the teeth from shifting after orthodontic adjustments.</p> Signup and view all the answers

    What is the primary purpose of the "vestibular shield" in the NAM technique?

    <p>To provide a platform for the nasal stents to attach securely, effectively molding the cartilages.</p> Signup and view all the answers

    Which of the following is NOT a common type of treatment for individuals with clefts?

    <p>Dental Implants</p> Signup and view all the answers

    Study Notes

    Cleft Lip and Palate

    • Cleft lip and palate are defects in the formation of the lip and/or palate.

    • Clefting occurs due to the failure of the lip and/or palate to properly fuse during fetal development. These processes contribute to the formation of the primary palate and secondary palate and are covered with ectoderm on the outside and filled with mesoderm on the inside

    • The merging of the medial nasal prominences with the maxillary and lateral nasal prominences is essential, breaking down the tissues connecting them, allowing for underlying tissue fusion.

    • If these protrusions don't properly fuse in a soft tissue state, a cleft occurs in the lip and palate.

    • Primary palate is formed by the fusion of the lateral nasal process with the medial nasal process and maxillary process.

    • Forward movement of the lateral nasal process during primary palate formation keeps it in contact with the medial nasal process, and interference with this movement can lead to a cleft.

    • Closure of the secondary palate depends on the tongue being cleared from between the palatal shelves. Its elevation and contact with the shelves is crucial at the correct time. Problems with this process frequently result in cleft palate.

    Etiology

    • Heredity (family history)
    • Consanguineous marriage
    • Alcohol consumption and smoking during pregnancy
    • Drug use during pregnancy (e.g., Phenobarbital, diphenylhydantoin, diazepam, cortisone)
    • Radiation exposure during pregnancy
    • Infectious disease during pregnancy (e.g., Rubella)
    • Excessive vitamin A consumption or deficiency
    • Folic acid deficiency
    • Teratogenic drugs
    • Physical and emotional stress during pregnancy

    Classification

    • Veau Classification: This classification system categorizes clefts based on the affected palate components (primary and/or secondary) and laterality (i.e. unilateral or bilateral).

      • Group I: Incomplete clefts of the soft palate and uvula (no involvement of the hard palate)
      • Group II: Clefts of the hard palate, soft palate, AND uvula (no involvement of the lip)
      • Group III: Complete unilateral clefts involving lip, alveolus, soft palate, and uvula
      • Group IV: Complete bilateral clefts involving lip, alveolus, hard palate, AND soft palate

    • Davis and Ritchie Classification: This system classifies clefts of the lip, distinguishing those that also include the maxillary alveolus and incorporating bilateral, unilateral, or median clefts.

      • Group I: Clefts of the lip (no maxillary alveolus inclusion); unilateral and bilateral
      • Group II: Clefts of the lip involving the maxilla (from the alveolus to the palate)
      • Group III: Clefts that extend to the alveolus (unilateral or bilateral; median cleft can be complete or incomplete)

    Types of Cleft Lip and Palate

    • Normal palate anatomy displays intact lip, uvula, hard and soft palate.

    • Cleft uvula is a split in the uvula.

    • Unilateral cleft of the secondary palate affects only one side of the palate.

    • Bilateral cleft of the secondary palate affects both sides of the palate.

    • Complete unilateral cleft lip and alveolar process of the maxilla with a unilateral cleft of the primary palate (anterior palate).

    • Complete bilateral cleft of the lip and alveolar process of the maxillae with a bilateral cleft of the anterior part of the palate.

    • (Additional diagrams and explanations of different types are provided)

    Prenatal Diagnosis

    • 3D Ultrasonography (typically during the second trimester, with 90% accuracy)
    • Magnetic Resonance Imaging (MRI)
    • Cleft lip occurs during the 6th week of pregnancy
    • Cleft palate appears around the 8th week of pregnancy
      • Allows for early identification enabling better preparation for the family's psychological needs, genetic assessment, and ensuring appropriate delivery circumstances.

    Clinical Manifestations of Cleft Lip and Palate Patients

    • Difficulty feeding (babies with cleft may find breastfeeding challenging).
    • Specialized feeding strategies (e.g., bottle feeding may be needed)
    • Speech distortion (potential difficulty pronouncing sounds)
    • Hypernasality (nose-like vocal quality)
    • Chronic otitis media (middle ear infections).
    • Hearing disorders, facial growth disturbances, and psychological consequences may also be seen.

    Dental Defects Resulting From Cleft

    • Anomalies in number of teeth (missing or extra teeth, particularly lateral incisors)

    • Position of lateral incisors is unpredictable

    • Abnormal tooth shapes (peg-shaped or malformed maxillary lateral incisors)

    • Defects of enamel (hypoplasia and opacities—thinning and discoloration)

    • Higher occurrences of caries (tooth decay).

    • Deviations in tooth eruption (teeth erupting improperly in relation to cleft area)

    • Tear-drop shaped defects impacting tooth eruption and proper root position

    • Importance of coordinating alveolar bone grafting with orthodontic tooth movement

    • Permanent canine emergence often impacted.

    Treatment

    • Team Approach (pediatrician, orthodontist, prosthodontist, plastic surgeon, dentist, laryngologist, and speech pathologist)

    • Infant Orthopedics (Nasoalveolar Molding (NAM)) - an early technique for molding the nasal structure.

    • Early Surgeries (lip and palate closure; typically 3-6 months for lip closure, 6-18 months for palatal closure)

    • Orthodontic Treatment (correcting jaw and tooth misalignments)

    • Orthognathic Surgery (surgical repositioning of the jaw bones)

    • Maxillary Distraction Osteogenesis: used for severe maxilla hypoplasia/scarring necessitating significant advancement of the Le Fort I segment.

    Bone Grafting

    • Most patients with alveolar bone clefts require bone grafting for future tooth movement and prosthetic restoration.
    • Common donor sites are iliac crest and calvarial bone.
    • Typically performed during mixed dentition.
    • Early alveolar bone grafting is crucial to prevent treatment discontinuities preparing for orthognathic surgery.

    Orthodontic Treatment

    • Significant discrepancy between maxillary and mandibular growth patterns can worsen with age.
    • Orthodontists play a crucial role in prevention, correction, and reducing cleft-related problems.
    • Orthodontic movement correction for crowding, congenitally missing/supernumerary teeth, and various relationships may be necessary.
    • Advanced cases may require complex treatments like orthopedic alignment or even surgical repositioning of the jawbones.

    Orthognathic Surgery

    • Maxillary advancement or jaw repositioning surgery occurs in cases where significant jaw misalignment is present or if the previous orthodontic treatment is not successful in achieving the desired results.

    Maxillary Distraction Osteogenesis

    • This procedure is reserved for cases of severe maxilla development issues and scarring, needing substantial advancement of the Le Fort I segment.

    Overall

    • Children with cleft lip and/or palate often face considerable social challenges and require empathetic care from dental professionals.

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    Cleft Lip and Palate PDF

    Description

    This quiz covers key aspects of NAM therapy and its effects on alveolar bone in patients with cleft lip and palate. You'll learn about the timing, duration, techniques, and advantages of NAM therapy, as well as the procedure of bone grafting. Test your knowledge on these critical components of cleft care.

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