27 Congenital - Cleft lip and palate

Question 1

What is m/c facial cleft

Answer 1

cleft uvula

Question 2

Which ethnic group has highest incidence of cleft lip

Answer 2

Native Americans

Question 3

Which ethnic group has highest incidence of isolated cleft palate

Answer 3

Equal incidence among racial groups

Question 4

M:F for cleft lip w/ or w/o cleft palate

Answer 4

2:1

Question 5

M:F isolated cleft palate

Answer 5

1:2

Question 6

Incidence of cleft lip w/ or w/o cleft palate in term newborns

Answer 6

1 in 1000

Question 7

Incidence of isolated cleft palate in term newborns

Answer 7

1 in 2000

Question 8

Incidence of submucous cleft palate in term newborns

Answer 8

1 in 1200

Question 9

Change of producing a cleft lipped child when one parent is affected

Answer 9

4%

Question 10

What is m/c single gene transmission error causing clefts

Answer 10

Trisomy 21

Question 11

What are m/c environmental causes for clefts

Answer 11

Poorly controlled maternal diabetes and amniotic band syndrome

Question 12

What is characteristic nasal deformity in a child w/ unilateral cleft lip

Answer 12

• Nasal tip and columella to non-cleft side

- Inferior, posterior, and lateral displacment of ala on the cleft side

Question 13

What happens to orbicularis oris in a complete cleft lip

Answer 13

Muscles fibers follow the cleft margins and terminate at the alar base

Question 14

What happens to orbicularis oris in an incomplete cleft lip

Answer 14

Muscle fibers remain continuous but are hypoplastic across the cleft

Question 15

What is Simonart’s band

Answer 15

The bridge of tissue connecting the central and lateral lip in an incomplete cleft lip

Question 16

What is the difference b/w a complete cleft of the primary palate and that of the secondary palate

Answer 16

A complete cleft of the primary palate extends into the nose, is always associated with a cleft lip, and does not expose the vomer.

A complete cleft of the secondary palate involves both the hard and soft palates, extends into the nose, and exposes the vomer.

Question 17

What is an incomplete cleft

Answer 17

A varying amount of midline mucosal attachment is preserved with an underlying muscular deficiency

Question 18

What type of cleft is a submucous cleft palate

Answer 18

Incomplete cleft of the secondary palate

Question 19

What happens to the soft palate muscles in a secondary cleft palate

Answer 19

Muscle fibers follow the cleft margins and insert into the posterior edge of the remaining soft palate

Question 20

What are the boundaries of u/l cleft of primary palate

Answer 20

From the incisive foramen anteriorly, b/w the canine and adjacent incisor to the lip

Question 21

What are the 2 m/c classification systems for clefts

Answer 21

Veau and Iowa classifications

Question 22

Feeding difficulties are most severe with which type of cleft

Answer 22

Secondary palate clefts (either isolated or in combo w/ clefts of lip and primary palate)

Question 23

What strategies can be used to assist feeding w/ cleft palate

Answer 23

Specialized nipples, upright feeding to minimize nasal regurg, palatal plates

Question 24

What % of kids w/ cleft palate do not require tympanostomy tubes

Answer 24

8-10%

Question 25

What further facial deformities often occur as a child w/ cleft palate grows

Answer 25

Collapse of alveolar arch, midface retrusion, and malocclusion

Question 26

What is role of palatal plates in tx of cleft palates

Answer 26

A palatal plate, when worn for 3 mo prior to surg and adjusted weekly to bring the palate and alveolus into a more nl shape has been shown to lessen closure tension during surgery

Question 27

Which sounds are most difficult for patients w/ cleft palate

Answer 27

consonants (as they require full palatal lift)

Question 28

What d/o should be suspected in kids with cleft palate who fall below 5th percentile in growth

Answer 28

Growth hormone deficiency as it is 40x more common in this population