Ch. 2 Flashcards
What is a cleft?
-Abnormal _______ or fissure in an anatomical structure
-Usually a _______ _______ due to abnormal fusion of parts during embryological development
-Can be due to ________ surgery
-Vary in ________ and __________
-Follow _________ __________ lines
Length of ____________ suture line.
-Abnormal opening or fissure in an anatomical structure
-Usually a congenital malformation due to abnormal fusion of parts during embryological development
-Can be due to ablative surgery
-Vary in type and severity
-Follow embryological suture lines
Length of medial suture line.
Embryological Development is dependent on the formation of _______________.
neural crest cells in embryo
Where are neural crest cells found?
between the neural tube and the epidermis of an embryo
Cells migrate to form ______.
skull and face
Causes of clefts:
- _________ or ________ factors delay cell ___________ and palatal shelf movement.
- This can cause the embryo to miss the period of _________ _________fusion.
- Genetic or environmental factors delay cell migration and palatal shelf movement.
- This can cause the embryo to miss the period of epithelial cell fusion.
Multifactorial Inheritance: Endogenous (internal) factors
Chromosomal disorders
Genetic disorders
Multifactorial Inheritance: Exogenous (external) factors
Drugs: phenytoin (Dilantin), valium, and corticosteroids
Viruses (rubella, influenza)
Teratogens (smoking, lead)
Nutritional deficiencies or maternal obesity
Mechanical interference
Lip (primary palate) begins at
7 weeks
Palate (secondary palate) begins at
9 weeks
should be finished by 12 weeks
Embryological closure begins at
_______ ___________ and “zips” …
-____________ to form the alveolar ridge and then lip
-____________ to form the hard palate and velum
incisive foramen and “zips” …
- forward to form the alveolar ridge and then lip
- backward to form the hard palate and velum
Clefting Severity occurs from
the _______ in to the incisive foramen
the ________ in to the incisive foramen
the lip in to the incisive foramen
the uvula in to the incisive foramen
right side of the lip
may close first.
Oral surface of the velum
Oral surface of velum may close first.
Primary Palate (Cleft Lip) Fuses around \_\_\_ weeks of gestation \_\_\_\_\_\_\_\_ to incisive foramen Includes \_\_\_\_\_\_\_ and \_\_\_\_\_\_\_\_\_ Clefts include: \_\_\_\_\_\_\_\_ or \_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_ or \_\_\_\_\_\_\_\_\_\_\_
Fuses around 7 weeks of gestation Anterior to incisive foramen Includes lip and alveolus Clefts include: Complete or incomplete Unilateral or bilateral
Secondary Palate (Cleft Palate Fuses around \_\_\_ weeks of gestation \_\_\_\_\_\_\_\_ to incisive foramen Includes \_\_\_\_\_\_\_\_\_\_\_ and \_\_\_\_\_\_\_\_ Clefts include: \_\_\_\_\_\_ or \_\_\_\_\_\_\_\_\_\_\_\_\_\_
Fuses around 9 weeks of gestation Posterior to incisive foramen Includes hard palate and velum Clefts include: Complete or incomplete
identify cleft lips and palates
see photos from powerpoint
Simonart’s Band
band of soft tissue that bridges a cleft of the lip
May be due to amniotic bands
Primary Palate: effect on structure Cleft \_\_\_\_\_\_ and orbicularis oris Wide, \_\_\_\_\_\_\_ nose with spreading nasal ala Short \_\_\_\_\_\_\_\_\_ Abnormal \_\_\_\_\_\_\_
Cleft lip and orbicularis oris
Wide, flat nose with spreading nasal ala
Short columella
Abnormal dentition
Primary Palate: effect of Function
Specific ________ errors
_________ affected
Specific articulation errors
Resonance affected
Secondary Palate: effect on structure
Absent ____ _________
Altered ______ of the levator velar muscles (cleft muscles of Veau)
Abnormalities in ______ _________
Absent velar aponeurosis
Altered insertion of the levator velar muscles (cleft muscles of Veau)
Abnormalities in nasal septum
Secondary Palate: effect on Function
_________ ____________ (speech and resonance affected)
Feeding problems and ______ ________
_______ _________ malfunction
Velopharyngeal insufficiency (speech and resonance affected) Feeding problems and nasal regurgitation Eustachian tube malfunction
Submucous Cleft: Overt
visible from oral surface
Submucous Cleft: occult
normal on the oral surface, abnormal on the nasal surface
Classic Stigmata of an overt sub mucous cleft
- _______ or hypoplastic (small and underdeveloped) uvula
- ______ _________—thin, bluish area in middle of the velum
- _______ in the hard palate where the posterior nasal spine should be, if the submucous cleft extends that far
- Muscles often ______ in the same way as a complete cleft palate
- Bifid or hypoplastic (small and underdeveloped) uvula
- Zona pellucida—thin, bluish area in middle of the velum
- Notch in the hard palate where the posterior nasal spine should be, if the submucous cleft extends that far
- Muscles often affected in the same way as a complete cleft palate
Submucous cleft:
Affects _______ of the levator veli palatini muscle
Levator muscle inserts on the _____ ______ of hard palate rather than in the _____ of the ______
Affects interdigitation of the levator veli palatini muscle
Levator muscle inserts on the posterior border of hard palate rather than in the middle of the velum
Submucous Cleft effects on structure
Depends on the ______
May have virtually ___ ______
May have the same effects as an _____ cleft palate as follows:
Structure
Altered ______ of the levator velar muscles (cleft muscles of Veau)
Depends on the extent
May have virtually no effect
May have the same effects as an overt cleft palate as follows:
Structure
Altered insertion of the levator velar muscles (cleft muscles of Veau)
Submucous Cleft effects on function \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_ (speech and resonance affected) Feeding problems and \_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_ malfunction
Velopharyngeal insufficiency (speech and resonance affected) Feeding problems and nasal regurgitation Eustachian tube malfunction
Holoprosencephaly: failure of the ____________ (the embryonic forebrain) to divide into _______ ________ of the cerebral hemispheres. The result is a _______-________ brain structure.
failure of the prosencephalon (the embryonic forebrain) to divide into double lobes of the cerebral hemispheres. The result is a single-lobed brain structure.
Facial Clefts can be caused by
genetic defects
amniotic bands
Two types of facial clefts
Oblique: slanting
Midline: middle of the face
Facial clefts effects on structure and function
Structural abnormalities on the ______ the head (face or skull) usually suggest abnormalities on the ______ of the head (face or skull).
Abnormalities on the ______ the head (face or skull) usually affect function of the following:
_________
_________
_________
_________
_________
_________/___________
Structural abnormalities on the outside the head (face or skull) usually suggest abnormalities on the inside of the head (face or skull). Abnormalities on the inside the head (face or skull) usually affect function of the following: cognition language speech resonance hearing feeding/swallowing
Cleft lip occurs…
twice as often in males (with or without cleft palate
Cleft palate occurs…
twice as often in females
Submucous cleft prevalence
Essentially unknown
May not cause problems with speech
May become symptomatic after adenoidectomy
Facial Cleft prevalence
very rare
TX of clefts: cheiloplasty
to close the lip
TX of clefts: palatoplasty
to close the palate
TX of velopharyngeal insufficiency affecting speech
pharyngeal flap or sphincter pharyngoplasty
