Sandler Paul Jonathan, Murray Alison, Orr Robert, Madahar Arun K
Dent Update. 2014 Jan-Feb;41(1):20-2, 24-6. doi: 10.12968/denu.2014.41.1.20.
Patients with a cleft lip and palate (CLP) deformity require the highest standard of care that the NHS can provide and this requires multidisciplinary care from teams located in regional cleft centres. Care of these cases is from birth to adulthood and requires several phases of intervention, corresponding to the stages of facial and dental development. Management ideally starts pre-natally, following the initial diagnosis, and occasionally pre-surgical appliances are prescribed. The lip is ideally repaired within three months, followed by palate closure between 12 and 18 months. Careful monitoring is required in the first few years and ENT referral, where necessary, will diagnose middle ear infection, which commonly affects CLP patients. Speech therapy is an integral part of the ongoing care. Excellent oral hygiene is essential and preventive dietary advice must be given and regularly reinforced. Orthodontic expansion is often needed at 9 years of age in preparation for a bone graft and, once the permanent dentition erupts, definitive orthodontic treatment will be required. Maxillary forward growth may have been constrained by scarring from previous surgery, so orthognathic correction may be required on growth completion. Final orthodontic alignment and high quality restorative care will allow the patients to have a pleasing aesthetic result. CLP patients and their families will need continuing support from medical and dental consultants, specialist nurses, health visitors, speech and language specialists and, perhaps, psychologists. The first article in this series of two outlined the principles of care for the CLP patient and this second part illustrates this with a case report, documenting one patient's journey from birth to 21 years of age.
A successful outcome for CLP patients requires a sound dentition.The general dental practitioner role is vital to establish and maintain excellent oral hygiene, a healthy diet and good routine preventive and restorative care. Understanding the total needs of CLP patients can help the dentist to provide high quality care as part of the multidisciplinary management.
唇腭裂（CLP）畸形患者需要国民保健服务（NHS）所能提供的最高标准护理，这需要区域腭裂中心的团队提供多学科护理。这些病例的护理从出生到成年，需要几个干预阶段，与面部和牙齿发育阶段相对应。理想情况下，管理在初步诊断后于产前开始，偶尔会开术前矫治器。理想情况下，唇裂在三个月内修复，随后在12至18个月之间进行腭裂修复。在最初几年需要仔细监测，必要时耳鼻喉科转诊将诊断中耳感染，这在CLP患者中很常见。言语治疗是持续护理的一个组成部分。保持良好的口腔卫生至关重要，必须提供并定期强化预防性饮食建议。通常在9岁时需要进行正畸扩弓，为骨移植做准备，一旦恒牙萌出，将需要进行确定性正畸治疗。上颌前突生长可能因先前手术的瘢痕而受限，因此在生长完成后可能需要进行正颌矫正。最终的正畸排齐和高质量的修复护理将使患者获得满意的美学效果。CLP患者及其家人将需要来自医学和牙科顾问、专科护士、健康访视员、言语和语言专家，或许还有心理学家的持续支持。本系列两篇文章中的第一篇概述了CLP患者的护理原则，这第二篇文章通过一个病例报告来说明这一点，记录了一名患者从出生到21岁的历程。
CLP患者的成功治疗需要良好的牙列。普通牙科医生的作用对于建立和维持良好的口腔卫生、健康饮食以及良好的常规预防和修复护理至关重要。了解CLP患者的全部需求有助于牙医作为多学科管理的一部分提供高质量护理。
