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Management of patients with non-syndromic clefts of the lip and/or palate part 1: from antenatal diagnosis to primary surgery Grant T McIntyre Dental Update 2024 41:8, 707-709.
Patients with clefts of the lip and/or palate require input from a diverse group of medical, surgical, dental and parasurgical specialties working as part of a multidisciplinary team in the UK. Co-ordinated care ensures that the patient receives optimal treatment whilst minimizing the burden of care for the NHS and family. The primary care dentist has an important role in the overall management of patients with clefts. Because the dentist-patient/parent relationship is of a long-term nature, the primary care dentist can also provide useful support and advice for families as they progress through the care pathway. This three-part article will illustrate the integration of dentistry with the other aspects of care.
Clinical Relevance: Dentists should be aware of the different types of cleft lip and/or palate that occur and the role of the dentist in the overall management of patients who have clefts.
Article
Non-syndromic clefts of the lip and palate include cleft lip with or without cleft palate [CL(P)] and isolated cleft palate (CP). The variety of CL(P) phenotypes includes:
The lip cleft can be further described as complete or incomplete depending on whether the cleft extends into the base of the nose or not.
Figures 1–4 show the main non-syndromic types of cleft that dentists are likely to encounter: a unilateral cleft lip (incomplete), a unilateral cleft lip and palate (complete), a bilateral cleft lip and palate (complete) and an isolated cleft palate.
Globally, the incidence of cleft lip and palate is approximately 1.35 in every 1000 live births,1,2 meaning that a baby with a cleft is born somewhere in the world every 3.6 minutes. There is, however, considerable geographical and ethnic variation in the epidemiology and, in the UK, the birth prevalence rate is approximately 650 cases per year, accounting for 65% of all congenital craniofacial abnormalities.3 Interestingly, the ratio of CL(P) to CP is approximately 2:1 in England and Wales (Table 1), however, there is an increased prevalence of CP in Scotland and N Ireland and, as a result,4,5,6 the ratio approximates 1:1. In general, boys have an increased prevalence of CL(P) when compared to girls (2:1), whilst girls are more likely to be affected by CP (1:2).
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