21 Cleft lip and palate
Karen, a 9-year-old girl, is unhappy about the appearance of her teeth (Fig. 21.1). What is the cause and how will it be treated?
Karen does not like the crookedness and spacing of her upper front teeth. Her mother is aware that the bite of Karen’s side teeth is not correct also and feels that she moves her jaw to the side when she closes her teeth together.
It affects about 1 in 750 live births among Caucasians but the prevalence varies between racial groups as well as geographically, and is increasing. Cleft lip only is found in about 9% of all clefts whereas cleft of the lip and alveolus comprises about 3% of all clefts. Complete unilateral cleft lip and palate is the most common type of cleft and represents 50% of all clefts.
Failure of fusion of the median and lateral nasal processes and the maxillary process at about 4–6 weeks of intrauterine life leads to a cleft of the primary palate (the upper lip and the alveolus in the anterior region as far posteriorly as the incisive foramen). Cleft of the secondary palate (hard palate from incisive foramen back and soft palate) is due to failure of the palatal shelves to elevate and fuse at about 8 weeks.
Why is this? What treatment will have been provided to date and what role have you to play as her general dental practitioner?
Due to the multidisciplinary care required, treatment is facilitated for the patient and family by coordinating management in a specialized centre by a team comprising an orthodontist, speech therapist, health visitor and clinical psychologist as well as plastic, ENT and maxillofacial surgeons.
Parental counselling by a member of the Cleft Lip and Palate Association and /or clinical psychologist as well as reassurance of the future treatment by an orthodontist and member of the surgical team.
Advice and support to the parents by a specialized health visitor, particularly in relation to feeding. In this case, feeding problems are likely to have been modest as the cleft only involves the primary palate.
Planning of lip repair: this usually occurs at 3 months. In this case, closure of the alveolar defect may be undertaken at the same time. Where a palatal cleft exists, on average, this is repaired at around 9 months.