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Cleft Palate > A&P > Flashcards

A&P Flashcards

1
Q

3 Parts of the Palate

A
  1. Primary = Premaxilla (alveolar ridge)
  2. Secondary = hard palate
  3. Velum = thing of its own
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2
Q

Craniofacial Anomalies

A
  • Abnormal structures of head & face

- Congenital

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3
Q

Highest to Lowest Incidence Rates in order by Race

A

Native Americans, Japanese, Chinese, White, African-American

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4
Q

Levator Palatini Muscle

A
  • Most important part of velum for VP closure

- Contracts up & out to elevate & retract velum

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5
Q

Cleft Lip

A

Opening in the lip (usually upper lip. Lower lip is rare)

  • Cleft lips are rare & usually accompanied by cleft palate (but not the other way around)
  • Congenital & present at birth
  • More commonly unilateral & on left side, but can be bilateral
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6
Q

Submucous Cleft Indicators

A
  • Zona Polusada = tissue looks blue
  • Bifid Uvula
  • Tenting
  • History of food out of nose
  • Hypernasal
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7
Q

Cleft Palate Basics

A
  • Various Congenital Malformation resulting in opening in hard or soft palate, or both
  • About 1 in 600-750 births are dx with clefts
  • More males have greater severity
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8
Q

Craniofacial Development in Utero

A

6-8 wks - primary palate forms
8-10 wks - secondary palate forms
9-12 wks - cleft fully formed
14 wks - face fully formed

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9
Q

Cleft Classifications

A

Cleft Lip - compete, incomplete, unilateral, bilateral
Cleft of Alveolar Processes - Unilateral, Bilateral, Median, Submucous
Cleft Palate (soft, hard, submucous)
Cleft prepalate, palate
Other Facial Clefts (horizontal, lower mandibular, lateral oro-ocular, naso-ocular)

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10
Q

Obligatory Errors

A

Affect manner more than anything.

Hard to understand but it’s out of their control.

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11
Q

Compensatory Errors

A

Affect place.

Intelligible but takes a long time to correct.

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12
Q

Hearing Issues with CP

A
  • OME

- Eustachian tube dysfunction -> conductive HL -> prob with tensor palatini

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13
Q

Articulation Issues with CP

A
  • Diff. with voiceless sounds
  • Sound distortions
  • Pressure Consonant issues
  • NAE -> consonants
  • Substitutions of stops, fricatives, affricates with post. movements/glottal stops/unusual movements
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14
Q

Language Issues in CP

A
  • Not usually affected unless they have other dx

- Initially delayed exp. lang. but usually “normal” by age 4

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15
Q

CP Assessment of Velopharyngeal Adequacy

A
  • Nasopharyngoscopy
  • Oral Manomter - suck or blow from mouthpiece
  • Nasometer
  • Orofacial exam
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16
Q

CP Assessment of Speech

A
  • Not standardized

- Iowa Pressure Artic Test

17
Q

CP Assessment of Voice & Resonance

A
  • Visipitch or Phonatory Function Analyzer

- PJs for Voice & Resonance

18
Q

Surgical Management of Cleft Lips

A
  1. Straight Line:
    tight, restrict growth of maxilla, no longer done
  2. Tennison-Randall
    Triangular flap, lip cut away, very tight, for uni or bilateral
  3. Millard
    Most common. Rotation Advancement Technique. Don’t lose tissue - extra length added. Uni or bilateral
19
Q

One-Stage Repair

A
  • 10-24 months (10-15 months earliest)
  • Velum & HP fixed together, not lips
  • Free-Flap: tissue comes from arm/knee
  • Furlow Z-Plasty: soft palate made longer
  • V-Y Retroposition aka Wardill Pushback: soft tissue closure to center
  • Von Langenbeck: release hard palate tiss.
20
Q

Two-Stage Repair

A
  • 12-24 months
  • Now shunned!
  • Fixed velum then HP thinking cleft would resolve on its own.
21
Q

Maxillary Osteotomy

A
  • Major disruption of blood, nerve supply & growth can bring face forward.
  • Le Fort Procedures! done by oral maxillary surgeon or craniofacial surgeon
    Result in VPI -> hypernasality. Small adenoid pad, short VP
    Not done until facial growth complete
    Three types of Le Fort:
    I: alveolar brought forward
    II: Maxilla moved forward
    III: includes eye orbit - craniofacial surgeon
22
Q

Non-Surgical Options

A
  • Obturator - plug hole with retainer

- Lifts - appliance under velum to lift it -long term teeth extractor

23
Q

Language eval for CP

A
  1. Lang eval
  2. FNAE & Hypernasality
  3. Dev. Errors, Phono Processes
  4. Endoscopic eval
  5. Inform family about S&L development
  6. Inform about abnormal speech

Cleft Palate (2 decks)

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