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Questions and Answers
What is the primary goal of alveolar bone grafting in the mixed dentition stage?
What orthodontic appliance is commonly used to expand the collapsed maxillary arch before graft placement?
At what age is alveolar bone grafting typically carried out?
What is the primary benefit of providing an intact arch through alveolar bone grafting?
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What type of surgery is often required in the permanent dentition stage to correct the skeletal Class III relationship?
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What is the primary goal of orthodontic treatment in the mixed dentition stage?
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What is the benefit of using a facemask with maxillary expansion plate in the mixed dentition stage?
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What is the typical orthodontic appliance used in the permanent dentition stage?
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At what age is the surgical repair of cleft lip usually carried out?
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What is the primary responsibility of the specialized nurse in cleft care?
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What is the purpose of presurgical orthopaedic alignment of the cleft alveolar segments?
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When is speech assessment typically started in cleft care?
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What is the term used for the process of adding nasal stents to improve alar support?
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In some European centres, closure of the hard palate is delayed until what age?
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What type of surgery may be needed to improve velo-pharyngeal insufficiency?
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At what age is pharyngeal surgery usually performed?
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What percentage of CLP patients require orthognathic surgery?
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When should prosthetic replacement be considered in CLP patients?
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What type of surgeries may be involved in CLP management?
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Why is a multidisciplinary team approach crucial in CLP management?
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What is the primary goal of standardized treatment protocols in CLP management?
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In what stage of dental development is prosthetic replacement typically considered?
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Why are standardized records essential in CLP management?
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What is the current limitation of CLP management in Egypt?
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What percentage of craniofacial malformations is comprised of cleft lip and palate?
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What is the approximate prevalence of cleft lip and palate among Caucasians?
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At what week of intra-uterine life does fusion of the maxillary and medial nasal processes occur?
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What is the position of the palatal shelves before fusion to form the secondary palate?
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What percentage of cases of cleft lip with or without cleft palate have a family history?
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What is the primary problem associated with cleft lip and/or palate?
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What determines the severity of problems associated with cleft lip and/or palate?
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What is the relationship between the growth of embryological processes and fusion?
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What is a potential consequence of velopharyngeal insufficiency on speech development?
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What is the primary consequence of surgical repair of a cleft lip and palate on facial growth?
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Which congenital anomaly is more commonly associated with isolated cleft palate?
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What is a potential dental anomaly associated with cleft lip and palate?
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What is the effect of unoperated clefts on facial growth?
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What is the consequence of bilateral clefts on the dental arch?
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What is the effect of tensor palati muscle involvement on hearing?
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What is the common consequence of a cleft involving the posterior part of the hard and soft palate?
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Study Notes
Mixed Dentition Stage
- Alveolar or secondary bone grafting involves placing cancellous bone into the maxillary alveolar defect, usually at around 8–10 years of age.
- This procedure provides an intact arch, improves alar base support, and allows for the eruption of the permanent canine or lateral incisor.
- Orthodontic treatment is usually required prior to graft placement to expand the collapsed maxillary arch and create surgical access.
Management of Cleft Lip and Palate
- Management involves a long-term, complex, multidisciplinary approach that starts from birth and extends to over 20 years of age.
- The team includes a cleft/maxillofacial surgeon, orthodontist, psychologist, nurse, speech therapist, and ENT specialist.
- A clinical nurse provides initial support and education to the mother for feeding the cleft baby.
- A period of active presurgical orthopaedic alignment of the cleft alveolar segments is occasionally carried out in the neonate to reduce the size of the cleft defect and facilitate surgical repair.
Surgical Repair
- Surgical repair of cleft lip is usually carried out between 3 and 6 months of age as a single procedure.
- Repair of cleft palate is normally undertaken between 6-9 months or 9 and 12 months of age.
- In some European centres, closure of the hard palate is delayed until 5 years of age to reduce the restriction effects of early surgery upon growth.
Orthodontic Treatment
- A period of orthodontic treatment is usually required prior to graft placement to expand the collapsed maxillary arch and create surgical access.
- Fixed appliances are used during the permanent dentition stage.
- Orthognathic surgery may be required to correct the skeletal Class III relationship.
Speech Development
- Speech development is adversely affected by velopharyngeal insufficiency.
- A cleft involving the posterior part of the hard and soft palate can also affect the tensor palati muscles, leading to hearing difficulties.
Complications and Associated Anomalies
- Cleft lip and palate are associated with other congenital abnormalities, such as heart and extremity defects.
- Delayed eruption, hypodontia, microdontia, and enamel defects are common dental anomalies.
- Individuals with unoperated clefts do not experience a significant restriction of facial growth, while those who have undergone surgical repair exhibit marked restriction of mid-face growth.
Epidemiology
- Cleft lip and palate is the most common craniofacial malformation, affecting approximately 1 in every 700 live births amongst Caucasians.
- The prevalence of cleft lip and palate varies geographically and between different racial groups.
- A family history can be found in around 40 per cent of cases of cleft lip with or without cleft palate.
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