Friday, March 18, 2011

Term Paper on Cleft Lip and Palate

Term Paper on Cleft Lip and Palate

What is a Cleft Lip and Palate?
A Cleft lip is a split in the upper lip. A Cleft palate is a split in the roof of the mouth. This leaves a hole between the nose and mouth. A cleft lip and palate affects 1 in 700 babies. Cleft lip and palate are not contagious, so you can't catch them from someone else.

Classifications of Cleft Lip/Palate
Class 1- Cleft of the tip of the uvula
Class 2- Cleft of the uvula
Class 3- Cleft of the soft palate
Class 4- Cleft of the soft and hard palates
Class 5- Cleft of the soft and hard palates that continues through the alveolar ridge on one side of the premaxilla.
Class 6- Cleft of the soft and hard palates that continues through the alvoelar ridge on both sides.


Etiology of Cleft Lip/Palate
Cleft lip and palate represent a failure of normal fusion of the embryonic processes during development in the first trimester of pregnancy.

Figure 44-2 shows the locations of the globular process and the right and left maxillary processes. with normal fusion, no cleft lip results.

Formation of the lip occurs between the fourth and seventh week in the utero. The development of the palate takes place during the eight to twelfth week. Fusion begins in the premaxillary region and continues backward toward the uvula.

A cleft lip becomes apparent by the end of the of the second mouth in utero. A cleft palate is evident by the end of the third mouth.

Risk Factors:
Genetic and Environmental factors can be significant. Rarely a single factor can be found as the specific cause. They are most often multifactorial.

Some factors are:
(a) Genetic
(b) Environmental
(c) Tabacco Smoke
(d) Alcohol Consumption
(e) Drugs
(f) Inadequate diet, vitamins
(g) Lack of adequate prenatal care

Signs and Symptoms
Symptoms of the cleft lip and cleft palate vary from person to person. A cleft lip may show up only as a small notch in the border of the upper lip. Cleft lip may involve one or both sides of the upper lip. Extra, missing, or deformed teeth may also be part of the cleft lip. Frequently, the outside of the nostril is somewhat flattened too. A cleft palate may involve the entire roof of the mouth. Cleft lip and cleft palate are birth defects that are usually visable at birth. Some mild types pf cleft palate may not be seen but can be detected by speech problems.

Oral Characteristics
(1) Tooth Development- disturbances in the normal development of the tooth buds occur more frequently in patients with clefts than in the general population. There is a higher incidence of missing and supernumerary teeth, as well as of abnormalities of the tooth form.

(2) Malocclusion- A high percentage pf patients with cleft lip and palate require orthodontic care.

(3) Open Palate- Before surgical correction sn open palate provides direct communication with the nasal cavity.

(4) Muscle Coordination- A lack of coordinated movements of the lips, tongue, cheeks, floor of motuh and throat may exist and lead to habits formed in the attempt to produce normal sounds while speaking.

(5) Peridontal Tissues- Bacterial plaque accumulation is influenced by the irregularly positioned teeth, inability to keep lips closed, mouth breathing, and the difficulities in accomplishing adequate personal oral care, especially around the cleft areas.

Early periodontal disease with loss of bone and clinical attachment at cleft sites is common in adolescents. Periodontal tissue loss in later years is greater at the cleft sites.

General Characteristics
(1) Other Congenital Anomalies- incidence is higher than that in noncleft people. In more than 30 disorders , cleft lip, cleft palate, or both represent one feature of a syndrome.

(2) Facial Deformity- facial deformities may include depression of the nostril on the side with the clrft lip, deficiency of upper lip, which may be short and over- prominent lower lip.

(3) Infections- upper respiratory and middle ear infections is common.

(4) Airway and Breathing- the abnormalities of the nose and throat area cause airway obstruction and breathing problems. Early treatment is necessary for the infant to lope with feeding problems.

(5) Speech- patients with cleft lip and/or palate have difficulty in making certain sounds.

(6) Hearing Loss- the incidence of hearing loss is significantly higher in individuals with cleft palate than in the noncleft popualtion.

Early Dental Care
With proper care, children born with a cleft lip and/or palate can have healthy teeth. This requires proper cleaning, good nutrition, and fluoride treatment. Appropriate cleaning wtih a small bristle tooth brush should begin as soon as teeth erupt. Many dentists recommend that the first dental visit be scheduled at about one year of age. The early evaluation is usually provided through the cleft palate team.

Coordinated Dental- Surgical Care
Coordination between the surgeon and the orthodontist becomes most important in the management of the bony defect in the upper jaw that may result from the cleft. Reconstruction of the cleft defect may be accomplished with a bone graft performed by the surgeon. The orthodontist may place an appliance on the teeth of the upper jaw tp prepare for the bone graft. A retainer is usually placed after the bone graft until full braces are applied.

Prosthodontic Care
The maxillpfacial prosthodontist is a dental specialist who makes artificial teeth and dental appliances to improve the appearance of individuals with cleft lip and to meet their functional requirements for eating and speaking. The prosthodontist may make a dental bridge to replace missing teeth. Oral appliances called "speech bulbs" or "palatal lifts" may help close the nose from the mouth so that speech will sound more normal.

Cleft Lip Surgery
Surgery is performed in the hospital under general anesthesia. The surgical procedure for closure of a unilateral cleft lip and nose deformity generally requires between 1-2 hours. The hospital stay is usually 24 hours.

After the surgery is completed, the child is taken to the recovery room for careful monitioring. Your baby will wear arm restraints to keep him or her from touching or disturbing the freshly reconstructed nose and lip.

Sutures in the lip are removed at approximately 5-7 days after the surgery. It will take two and a half to three weeks for the operative wound to gain sufficient strenght to resisit damage.

Bone Grafting
(1) Alveolar Graft: placed before eruption of maxially teeth at the cleft site, creates a normal architecture through which the teeth can erupt. A need for future prosthetic replacement of missing teeth is reduced. Support is provided for teeth adjacent to the cleft areas.

(2)Hard Palate Graft- provides closure of oronasal fistuale and helps to relieve a compromised airway.

(3) Sources for Autogenous Bone for Graft: Rib, iliac crest, skull, or mandible.

Appointment Considerations
(a) Patient Apprehension- a patient who has been seen often in hospital clinics may become "clinic tired" and be very apprehensive about dental and dental hygiene care.

(b) Communication
(1) Speech- speech may be almost unintelligible although with repeated contact, understanding can be developed.

(2) Hearing- depending on the severity of hearing loss, the approach is simialr to that for speech difficulties.

(3) Avoid Undue Sympathy- approach as a normal patient.

(4) Provide Motivations for Quite, Unresponsive or Bold Rebellious Types- use approach that helps them gain an objective attitude to the care of thier mouths.

Personal Factors
Most patients with a cleft lip or palate do not have more personality problems than people without clefts. Most young children think they are different. Parental acceptance or rejection no doubt can be a strong influence. A few characteristics are:

(1) Self- Consciousness- hypersensitivity to taunts or obvious pity.

(2) Feelings of Inferiority- the result may be a person who is quiet, unreponsive and withdrawn, or one who is openly rebellious.

Warning!!! All free sample term papers and college term paper examples on Cleft Lip and Palate topics are plagiarized and cannot be fully used in your high school, college or university education.

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