04 Surgery Flashcards
Describe a lip repair
To repair the muscular continuity of the upper lip
(Orbicularis oris)
To make the lip aesethelicty pleasing by closing the lip
This is done first unless there is a bilateral cleft
What is the rules of 10s?
Rule of 10’s. 10 lbs., 10 grams of hemoglobin (O2 in the blood) to tolerate the effects of anesthesia, and about 10 weeks of age
What is NAM (Nasal-Alveolar Molding)
-other procedures to bring the cleft segments closer together
with a Bilateral cleft you need to do what first?
You need to do a procedure to move the lip down, premaxilla, and nasal spine into the place with taping
The first type of lip repair was ___________
straight line repair
-Pulls down the nose and nare (kind of like a flap)
you cut off some tissue, raise tissue on the other side, and overlap the tissue
-used as an adhesion to pull alveolar segments together across a really wide alveolar cleft AND then do a typical repair later
What is the problem with a straight line repair?
It can be too tight so it tends to impede the growth of the maxilla
What is a Triangular flap repair, aka Tennison-Randall?
- Cuts out a section of tissue on both sides and then the lip can be pulled down, so you lengthen the lip a little bit
- Although you get lengthening you get tightening because tissue is removed
- Longer rostral dorsal line, but have more tension laterally from left to right
- Good for unilateral cleft
What is the Millard rotation-advancement technique ?
- is much more useful for a bilateral cleft because –you are not cutting out any tissue & pulling it away
- it’s a geometric design in order to get lengthening of the lip but no tissue is removed
- not as tight
When surgeons do a palate repair it is usually a ________
soft tissue repair
Describe a one stage surgical repair
- Done around 10-24 months of age
- Free flap repair
- The tissue is cut from the palatal shelves that are present—or surrounding structures—placed over the cleft and sutured into place
What are the two types of tissue you can cut from the palatal shelves?
a oral surface and nasal surface
Name the 5 types of free flap, one stage repair surgeries.
- Furlow z-plasty
- Von Langenbeck
- V-Y retroposition procedure, aka Wardill pushback
- Vomer flap
Explain a free flap repair
-Tissue taken from some place else and transplanted
-The exception: if you can’t scrape up enough tissue in the palate
Problem: establishing blood supply
T/F the furlow z-plasty if for the soft palate repair
True it is velum repair
-So they’ll cut the tissue, shift the tissue towards the posterior, and lengthen the soft palate
- tissue is removed from the nasal and oral side from the palatal shelves –> double cross over so the tissue pair is as strong as you can make it
- a z-plasty is normally a revision surgery if they didn’t get enough length in the first palatal repair
the Von Langenbeck surgery is typical for a _______ repair
hard palate repair
- Pulling up flaps of tissue, and then bringing it to the midline, bridging edges of tissue together with a surgical stitch
- can be done on oral or nasal surface
- pulling palatal tissue and tapering it over with the soft tissue
Describe the V-Y retroposition procedure, aka Wardill pushback
- There is no bone graphed
- they’re cutting these slits almost like vents or darts in the tissue
- > it will give you more length in the tissue
- you open up a gap by cutting it and pull the tissue backwards
-Lengthening your repair which will lengthen the velum
The Vomer flap may go with Wardill pushback, why?
- it creates Nasal septum flaps on the superior surface to cover a really massive gap
- on the oral side it’s not flaps, its opening vents BUT on the nasal side it may take tissue to close the clefts
- on the inferior surface (oral side) you might take off tissue from the nasal septum and paper over the large gap
What is a two stage surgery?
-Done around 12 and then 24 months
-A same surgical procedure but you fix the velum (z-plasty) wait a little bit for facial growth and then close the hard palate
-You Repair soft palate first
BUT no advantage so will disappear speech is worse
T/F a spreader causes a fistulae
False, it is due to pressure placed in that area;
at some point there is tissue dehiscence
Does a fistula always affect speech?
- no, effects depends on size and location
- In the alveolar ridge (anterior) practically has no affect, no matter the size
- A posterior fistula even though it’s really small may have a huge affect on speech
A functional fistula has an affect on what sounds and functions?
- on pressure consonants air will leak
- If a fistula has an effect on speech, eating, or drinking, as in air, food, or liquid can pass through it and gets into the nose
Orthognathic surgery is usually on the ?
- the most simple and most common surgery is the alveolar bone graft because of cleft in the alveolus
- Bone graft to the alveolus
- when the repair is initially done, it goes to the alveolus and it stops
- they remove bone from iliac crest (hip and skull are best)
Timing of the bone graft is controversial in Orthognathic surgery. What is the the average year?
about 9 or 10 years of age because incisors are coming in
- remember the issue is having enough room for the teeth to come in
- The hope is that the incisors and cuspids will come in where they’re supposed to through living bone
What is a maxillary osteotomy ?
-Surgical repairs on bone/tissue disrupt blood supply, nerve supply, growth.
-So, palate repair no matter what kind, in infancy may then later require corrective surgery to approximate a normal growth pattern
normalize profile and bite
-Cleft on it’s own has facial retardation growth and then tissue ruins growth
