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Amy's Class Notes on Cleft lip and palate (1999)
I don't know if these will help you out but just in case, I added them onto the site.  These are just notes that I took in class in different formats.

Cleft lip:

• a unilateral or bilateral congenital fissure in the upper lip usually lateral to the midline
• can extend into the nares and may involve the alveolar process
• caused by defect in the fusion of the maxillary and medial nasal process
  

Cleft palate:

• a congenital fissure in the palate caused by failure of the palatal shelves to fuse
• may extend to connect with unilateral or bilateral cleft lip.
  

Orburator:

• a prothesis designed to close a congenital or acquired opening, such as a cleft of the hard palate.
• small acrylic plate, is made to fit into the roof of the mouth and curves around the alveolar ridge to secure placement.
• This "artificial palate" may make feeding easier and with frequent adjustments can actually help bring the palatine shelves closer together
  

Classification:

• Class 1:  cleft of the tip of the uvula
• Class 2:  cleft of the uvula (bifid uvula)
• Class 3:  cleft of the soft palate
• Class 4:  cleft of the soft and hard palate
• Class 5:  Cleft of the soft and hard palate that continues through the alveolar ridge on one side of the premaxilla; usually associated with cleft lip of the same side.
• Class 6:  Cleft of the soft and hard palates that continues through the alveolar ridge on both sides, leaving a free premaxilla; usually associated with bilateral cleft lip.
• Class 7:  submucous cleft in which the muscle union is imperfect across the soft palate.  The palate is short; the uvula is often bifid; a groove is situated at the midline of the soft palate; and the closure to the pharynx is incomplete.
  

A Cleft lip may occur sometime between 4th and 8th week of gestation.

• occurs 1 in 1,000 births
• 60% to 80% are males
  

A cleft palate may occur sometime between the 6th and 12th week of gestation.

• occurs 1 in 2,500 births
• more common in girls than boys
  

Approximately 5,000 children are born with cleft palate or lip each year in the United States.

Predisposing factors:

• Infectious diseases
• nutritional deficiencies
• drugs (alcohol, steroids, anticonvulsant medications(dilatin))
• substance abuse
• cigarette smoking
• lack of prenatal care
  

Tooth Development:

• disturbances in the normal development of the tooth buds
• higher incidence of missing and supernumerary teeth
• abnormalties of tooth form
• malocclusion (need orthodontic care)
• open palate (provides direct communication with the nasal cavity)
  

Muscle coordination:

• Lack of coordinate movements of:
• lips
• tongue
• cheeks
• floor of mouth
• throat
• may lead to compensatory habits formed in the attempt to produce normal sounds while speaking
  

Gingival disturbances:

• created by effects of bacterial plaque accumulation influenced by:
• irregularly positioned teeth
• mouth breathing
• displaced teeth
• inability to keep lips closed
• difficulties in accomplishing adequate personal oral care.
  

Social deformity:

• depression of the nostril on the side of the cleft lip.
• deficiency of upper lip
• may be shirt or retroposed
• overprominent lower lip
  

Infections:

• predisposition to upper respiratory and middle ear infections is common.
  

Hearing loss:

• Higher incidence of hearing loss.
  

Speech:

• difficulty in making certain sounds.
• may produce nasal tones
  

Personal factors:

• self-consciousness
• hypersensitive to taunts or obvious pity
• feelings of inferiority
  

Treatment:

• cleft lip

1. 10 lbs. / 10 wks
2. infants general health is a determining factor.

• closure aids in:

1. feeding
2. development of the premaxilla
3. growth of the lip
4. may also help to partially close the palatal cleft

• obturator may be made for palate.

• Cleft palate

1. ages 1-2
2. purposes for early treatment

• improve child's appearance
• aid child's mental development
• prevent malnourishment by improving the feeding apparatus
• aid in the development of the speech pattern.
• reduce possibilities of repeated infections of the nasophararyngeal region
• maxillofacial surgery
  

Dental Hygiene Care:

Objectives for treatment planning:
--frequent appointments, scheduled every 3-4 months.

1. review plaque control measures

2. remove all calculus and smooth the tooth surface

3. provide topical fluoride
   

Appointment considerations:

• a patient who has often been in a hospital for oral surgery may be apprehensive about dental and dental hygiene care.

• speech may be almost unintelligible, although with repeated contact, understanding can be developed.
  

Infection control:

• fissure lines susceptible to infections
  

Instrumentation:

• techniques adapted.
  

Malaligned teeth:

• adjust scaling and root planing procedures.
  

Free Maxilla (unoperated older patient):

• related to bilateral cleft of alveolar ridge; avoid undue pressure with finger rests or instrument to prevent movement of the part.
  

Area of recent surgery:

• avoid pressure
  

Sensitive, enlarged gingival tissue that bleeds readily:

1. begin plaque control instruction before any instrumentation.

2. continue plaque control instruction as small sections of scaling are done over several appointments.

3. arrange follow-up appointments to check response of tissue.
   

Open Fissures:

• prevent debris or pieces of calculus from passing into or being retained in the clefts.  Whenever possible, use rubber dam for indicated procedures.
  

**A cleft lip may occur sometime between the 4th and 8th weeks of gestation.

**A cleft palate may occur sometime between the 6th and 12th week of gestation.

**Cleft lip occurs in 1 in 1,000 births.  60% to 80% of detected infants are males.

**Cleft palate in 1 in 2,500 births.  More common in girls.

**5,000 children born each year with cleft lip or palate in U.S.

**There are several teratogenic agents which have been associated with cleft palate. These include:

1. dilatin

2. trimethadione

3. alcohol
   

**Infants with cleft of the hard palate often have difficulty feeding.

**Often an obturator, a small acrylic plate, is made to fit into the roof of the mouth and curves around the alveolar ridge to secure placement.  This "artificial palate" may make feeding easier and with frequent adjustments can actually help bring the palatine shelves closer together.

**Breast feeding in an infant with cleft requires adjustments in the technique and considerable patience.  Feeding may be facilitated by using a breast pump.

**Children with cleft palate have an increased risk of having recurrent ear infections.  These problems are the result of inadequate function of the palatal muscles are which are needed to open the Eustachian tubes.  When the Eustachian tubes do not open effectively, the inner ear is not properly ventilated and fluid can accumulate in the middle ear.  The vast majority of children with cleft palate will require myringotomy tubes.

**Because of chronic middle ear infusions, many children with cleft palate experience some degree of hearing loss.

**Approximately 80% of children with cleft palate will develop intelligible speech after initial palatal surgery.  An initial speech and language assessment is usually performed between 3 to 6 months of age with follow-up evaluations every 6 to 12 months during the first few years of life.

**Lip surgery around 3 months.

**palatal surgery 9-12 months of age.