1229 Exam 5: Cleft lip palate Flashcards
Choamal Atresia
most common congenital anomaly of the nose
during the 6th week of pregnancy a membrane fails to properly develop and an obstruction occurs
life threatening d/t infants are nose breathers, can take up to 6-12 weeks to develop the ability to breathe through mouth
Is a bony or membranous septum located between the nose & pharynx
Maybe unilateral or bilateral
Bilateral
maybe associated with apnea & cyanosis when the infant is at rest
When infant cries & breathes in the mouth, they begin to “pink up”
Will require to be intubated immediately after birth
Unilateral
May not be associated with apnea
Inability to pass a suction catheter though the nose into the pharynx
Have cyanosis w/o obvious respiratory distress can lead to its detection
Nasal obstruction
Right nare
CT Scan
Axial CT scan of neonate with mixed bony-membranous choanal atresia. Note the posterior bony thickening with central membranous connection on both sides (arrowheads)
Symptoms
Cyclic respiratory distress relieved with crying
Noisy breathing (snorting)
Feeding difficulties (eat & breathe at same time)
Inability to pass a 5/6 French catheter into nasopharynx
Nasal drainage
Treatment
Depends on severity of the anomaly, how much it affects the child’s breathing & eating, & what other medical conditions are present
Surgery to open the nasal airways
Nasal stents to hold open the airway and stay in place for up to 1 year
Parent teaching on 24 hr monitoring, cleaning stents, and suctioning
Cleft Lip & Palate
Facial malformations that occur during embryonic development & are most common congenital deformaties of the head & neck
Can appear separately or together
Cleft Lip
is the failure of the maxillary & median nasal processes to fuse
develops between the 5th-8th week of gestation
Cleft Palate
is a midline fissure of the palate that results in the failure of the two sides to fuse
develops between the 7th-12th weeks gestation
Etiology
May be caused by exposure to ETOH, anticonvulsants, steroids, and retinoids
Use of phenytoin (dilantin) during pregnancy is associated with a tenfold increase incidence of cleft lip. Also diazepam (valium)
Smoking during pregnancy is twice as great incidence of cleft lip then those who do not
ETOH consumption in 1st trimester is associated with a higher incidence of oral clefts
Patho
Genetic defect in cell migration that results in a failure of the maxillary and pre maxillary processes to come together between the 3rd & 12th week of embryonic development
Cleft lip & palate are often seen together, but are each distinct & occur at diff times during the developmental process
Diagnostic Evaluation
Evident on birth
Small cleft of palate can be seen on visual inspection & palpitation
If not diagnosed at birth, formula coming from nose may be the 1st sign
Can be diagnosed in utero by ultrasound
Types of Cleft Lip/Palate
Cleft lip-3 mo-12lbs
Cleft Palate-1 year
Repair of Cleft lip
Repair of Cleft Palate
Results of Surgery
Long term complications
Speech difficulties
Malocclusion problems (abnormal tooth eruption)
Hearing problems
Major Emphasis after Surgery
Protection of the operative area Placed only on back side Arm or elbow restraints may be used Pain med Logan's Bow-heavy stainless steel wire bent in an arc & taped to both cheeks to protect a freshly repaired cleft lip
