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Craniofacial > Anatomy, Classification, Embryology, and Surgery > Flashcards

Anatomy, Classification, Embryology, and Surgery Flashcards

1
Q

Facial landmarks (7)

A 
Nasal tip
Alar base and rim
Philtral ridges
Philtrum
Columella
Cupid's bow
White roll
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2
Q

Hard palate anatomy

A

The premaxilla is from the tip of the maxilla to the incisive forame. The palatine process of the maxilla runs about halfway down the hard palate, and the palatine bone is the other half, ending in the posterior nasal spine.

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3
Q

Soft palate anatomy

A

The velum attaches posteriorly to the hard palate via aponeurosis (the buffer zone for muscles to insert into). The soft palate is primarily composed of muscle and soft tissue for mobility.

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4
Q

Pharyngeal anatomy

A

Nasopharynx
Oropharynx
Laryngopharynx

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5
Q

Velopharyngeal muscles (7)

A
  1. Tensor veli palatini–opens the eustacian tubes
  2. Levator veli palatini–lifts the velum; parallel to ET
  3. Palatoglossus–antagonist to LVP
  4. Palatopharyngous–vertical fibers lower velum; horizontal fibers create a sphincter action
  5. Superior constrictor–creates medial displacement of the lateral pharyngeal walls
  6. Musculus uvulae–bulk of velum
  7. Salpingopharyngeous–surface of velum, little functional significance
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6
Q

Innervation of VPC

A

Motor: Pharyngeal plexus
Sensory: Trigeminal, Vagus, Facial

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7
Q

Closure Patterns

A

Coronal–Velum meets with pharyngeal wall
Saggital–Pharyngeal walls meet horizontally
Circular–Velum and pharyngeal walls meet in the middle w/ or w/o help of adenoids

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8
Q

Potential problems with adenoid pad

A
  1. Can cause nasal obstruction
  2. Can cause culdesac resonance
  3. Can cause VPI
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9
Q

Levels of an embryo

A
  1. Ectoderm–>skin, teeth, hair, lens of eye, inner ear
  2. Mesoderm–>muscles, connective tissues, bones, heart
  3. Endoderm–>digestive system, liver, respiratory system, outer ear
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10
Q

Neural tube

A

Houses the brain of an embryo

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11
Q

Anatomy of embryo at 4 weeks

A 
Pharyngeal arches are present
1. Mandibular
2. Hyoid
3. Body of hyoid
Maxillary process present
Frontonasal process present
Nasal placodes present, become nasal pits, then nostrils
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12
Q

Anatomy of embryo at 5-6 weeks

A

Median and lateral nasal processes
Eyes are still very lateral
Interruption in week 6 will cause full CLP

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13
Q

Anatomy of embryo at 7 weeks

A

Maxillary process conncets to the median nasal processes
Nasal pits present
Ears lateral and low-set
Hyoid arch is almost-complete ring of tissue around EAM
Merging of primary palate in anterior direction
Oral and nasal cavities NOT separated
Hard palate created by merging of palatine processes and premaxillae
Palatal shelves are vertical

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14
Q

Anatomy of embryo at 9 weeks

A

Mandibular growth spurt–tongue lowers, palatal shelves elevate to separate nasal and oral cavities
Fusion starts are inc=cisive foramen and moves to uvula by week 12
Interruption here causes CPO

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15
Q

Potential problems with ears (3)

A

Aural atresia (closure of EAC)
Microtia
Preauricular pits/tags

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16
Q

Potential problems with eyes (6)

A 
Epibulbar dermoid (cyst on eye)
Exophtalamus (bulging eyes)
Hypertelorism (wide-set eyes)
Coloboma (defect in eye shape)
Narrow palpebral fissures
Strabismus
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17
Q

Potential problems with tongue (2)

A

Micro/macroglossia

Ankyloglossia

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18
Q

Potential problems with jaw (3)

A

Micrognathia
Retrognathia
Prognathia

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19
Q

Potential problems with head (4)

A

Micro/macrocephaly
Hydrocephaly
Brachycephaly (limited anterior/posterior growth)
Craniosyntosis (premature fusion of the cranial bones)

20
Q

Cause of CLP?

A

Multi-factorial inheritance (genetics+environment); sometimes related to syndromes

20% of cases are primarily inherited
3-5% are chromosomal
65% are primarily environmental or unknown

21
Q

Incidence of CLP

A

Most common birth defect; 1:595

25% Lip only (cleft on left lip in 70% of these)
25% palate only
50% CLP

Lowest incidence in African American population, highest in Native American population

CLP more common in males
CPO more common in females

22
Q

What percentage of children with CLP have another abnormality?

A

14-15%

23
Q

Cleft classifications (basic)

A

Lip and/or palate

Complete (formed before 9th week) or incomplete (formed during 9th week)

Unilateral or bilateral

24
Q

Cleft classifications (advanced)

A

Primary or secondary palate

Submucous cleft

25
Q

8 people who may be on a cleft team

A 
SLP
Audiologist
Nurse
Pediatrician
Prosthodontist
Orthodontist
Geneticist
Social worker (many others as well)
26
Q

Advantages of team care

A

Centralized and coordinated services
Maximize communication between specialists
Long-term treatment planning

27
Q

Typical timeline for CLP

A 
Lip taping=birth, in hospital typically
Nasal-Alveolar molding=before 3 mo.
Lip repair=3 mos., rule of 10’s
Initial SLP Eval
Palate repair= 12 mos.
Post-op speech eval
Speech follow-up every 6-12 months or sooner
Lip revision= after age 5-6, ideally early teenage years (9-12yrs); avoid midface growth deficiencies
Secondary surgical revision to palate if needed
Maxillary expansion, 6-9 years
Bone grafting, 9-12 years
Orthodontics
28
Q

SLP’s role on cleft team

A 
Provide support to family
Provide input to team members
Re-eval yearly
Initiating referrals
Community resource
29
Q

Types of occulsion

A

Class 1: Normal
Class 2: Mandibular retrusion/maxillary protrustion)
Class 3: Mandibular protrustion/maxillary retrusion)

30
Q

Other dental problems

A 
Overjet (space between top and bottom teeth)
Crossbite 
Over/underbite
Supernumerary teeth
Missing teeth
Rotated teeth
31
Q

Palatal lift

A

Raises velum; good for VPI caused by reduction in velar movemetn

32
Q

Palatal obturator

A

Prosthetic that covers cleft in CP; nonsurgical option

33
Q

Speech bulb

A

Only worn when speaking; occludes the nasopharyngeal port to eliminate nasality

34
Q

Audiological problems

A

Bilateral conductive hearing loss; prone to ear infections

35
Q

Rule of 10s

A

Before surgery, child should be:
10 weeks old
10 pounds
10 hemoglobin g/dl

36
Q

Primary lip repair

A

Occurs at 3 months. Can be a straight-line repair, a triangular repair, or a rotational advancement

37
Q

Logan bar

A

Used to reduce tension on the surgical site after a lip repair (same function as lip tape)

38
Q

Palate repair timing

A

Occurs between 9 and 18 months (12-15 on average)

39
Q

Von Langenbeck repair

A

Palate repair that brings the structures in a straight midline

40
Q

Wardill-Kilner repair

A

Palate repair that closes the palate leaving a V or Y shaped scar

41
Q

Furlow Palatoplasty

A

Palate repair that creates a z shaped scar and lengthens the velum

42
Q

Care after palatoplasty

A

Elbow restraints; clear diet (later upgraded to puree); restricted from bottles, passies, spoons, etc.; limited to cup drinking for feeds

43
Q

Secondary lip surgery timing

A

Before 5 years old–typically improves facial appearance before entering school

44
Q

Reasons for secondary palate repair

A
  1. Palatal fistula or dehiscience
  2. Correction of maxillary/mandibular problem
  3. Correction of VPD (occurs in 10-20%)
45
Q

Sphincterpharyngeoplasty

A

Secondary palate repair procedure that uses the pharyngeal flaps to narrow the sphincter–good for smaller VP gaps, good velar movement/poor pharyngeal wall movement

46
Q

Pharyngeal flap procedure

A

Secondary palate repair procedure that creates a midline pharyngeal flap with lateral ports for breathing; good for larger VP gaps with good lateral pharyngeal wall movement

47
Q

Pharyngeal wall augmentation

A

When material is injected into the pharyngeal wall to narrow the sphincter when VP gap is small

Craniofacial (5 decks)

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