Clinical Cleft: Lip and Palate PDF

CLINICAL CLEFT - To explain what cleft of the lip and palate is - Anatomical anomaly from failure of fusion of dentofacial development - 65% of anomolys affecting head and neck - 1:700 - High prevalence in Asians - Increasing prevalence - Family history influence - To describ...

CLINICAL CLEFT - To explain what cleft of the lip and palate is - Anatomical anomaly from failure of fusion of dentofacial development - 65% of anomolys affecting head and neck - 1:700 - High prevalence in Asians - Increasing prevalence - Family history influence - To describe the epidemiology, factors and diagnosis for cleft lip and palate - 1/20 chance for unaffected parents having child w this anomaly - If either parent have it 2-8% - Males\>females - LHS\>RHS - Might have environmental factors - Drugs can increase chance; vit A, heroin, anticonvulsant drugs, folic acid deficiency, steroid therapy - To relate the causes to the stage of foetal development - Polygenic inheritance w threshold - Secondary palate makes 2 shelves that are vertical to either side of tongue - Tongue lowers and shelves elevate to join at midline - Happens at 9-10w of pregnancy - Tongue fail to drop/fusion fail/breakdown of joint = cleft - Can very in size Cleft subdivided based on anatomical limit: - Primary palate = lip + alveolus - Lip + palate cleft - Palate only Cleft lip and Cleft palate embryology, features, and management Lip + cleft palate: - Complete cleft = communicates directly w nasal cavity - Unilateral cleft = minor segment of alveolus moves palatally -\> collapses inwards -\> makes cleft larger Cleft palate only: - Only secondary palate involved - May have submucous cleft where muscle isn't joined but mucosa is intact - To describe the stages of early treatment in children Case management: - Ante-natal (during preg) care = defects detected - If cleft is diagnosed -\> referral to cleft team for counselling - Can also be diagnosed on birth -\> asap referral to cleft team Cleft issues: - Each cleft = different problems -\> functional + aesthetic - Immediate priority = breathing + feeding - Breathing problems = retrognathic mandib - Common w Piere-Robin syndrome - Special feeding bottles (rosti) and feeding positions - Early lip surgery = good aesthetics. Speech development, feeding, intact dentition CLP team: - Orthodontist - Maxillofacial surgeon - Plastic surgeon - Speech therapist - Ear, nose, throat surgeon - Specialist health visitor Palate repair takes around 6 months Lip repair usually btw 6-12 weeks May have some hearing impairment -\> compromised muscles surrounding inner auditory meatus Othro implications: - Hypodontia - Supernumerary - Microdontia - Abnormal tooth size/shape - Impacte max canines - Ectopic eruption og 6's - Enamel hypoplasia - Crossbite - Bone defect - Class III incisor