Chapter Two Flashcards
What Is a Cleft?
Usually a _______
malformation due to abnormal fusion of parts during _______
Can be due to ______
Abnormal opening or fissure in an anatomical structure
congenital; embryological development
ablative surgery
Clefts
Vary in ___and _____
Follow embryological _____lines
type
severity
suture
Embryological Developmentof the Lip and Palate
Embryological development is dependent on formation of ______ cells in embryo.
Through the process of _______
Neural crest cells are found between the ____and the ____ of an embryo.
Cells migrate to form ______
neural crest
organogenesis
neural tube and epidermis
skull and face.
Causes of Clefts
_____or ______factors delay cell migration and palatal shelf movement.
This can cause the embryo to miss the period of ______
Genetic or environmental
epithelial cell fusion.
Causes of Clefts
Multifactorial Inheritance: Endogenous (internal) factors
Exogenous (external) factors (e.g., teratogens)
Chromosomal disorders
Genetic disorders
Drugs: phenytoin (Dilantin), valium, and corticosteroids
Viruses (rubella, influenza)
Teratogens (smoking, lead)
Nutritional deficiencies or maternal obesity
Mechanical interference
Embryological Development***
Lip (primary palate)
Palate (secondary palate)
Development is _______.
begins at 7 weeks.
begins at 9 weeks.
independent
Embryological closure begins at incisive foramen and “zips” …
Structures closest to the incisive foramen…
forward to form the alveolar ridge and then lip
backward to form the hard palate and velum
fuse first
Embryological Development
Clefting severity occurs from…
____side of lip may close first.
_______ may close first.
Clefting starts in the strictures that are _____from the incisive foramen.
the lip in to the incisive foramen
the uvula in to the incisive foramen
Right
Oral surface of velum
farther
Classification of Clefts Primary Palate (Cleft Lip)
Fuses around ___weeks of gestation
______to incisive foramen
Includes ___and ____*** (can be one or both)
Clefts include:
7
Anterior
lip and alveolus
Complete or incomplete
Unilateral or bilateral
Classification of Clefts Secondary Palate (Cleft Palate)
Fuses around ___weeks of gestation
_____to incisive foramen
Includes ___________
Clefts include:
9
Posterior
hard palate and velum
Complete or incomplete
Unilateral incomplete cleft lip
Image
Unilateral complete cleft lip
Image
Bilateral incomplete cleft lip
Image
Bilateral complete cleft lip
Image
Clefts of the Primary Palate:Types and Severity
Simonart’s Band—
May be due to _____
band of soft tissue that bridges a cleft of the lip
amniotic bands
(Image)
Clefts of the Primary Palate: Effects on Structure and Function
Structure 1. 2. 3. 4.
Function
1.
2.
- Cleft lip and orbicularis oris
- Wide, flat nose with spreading nasal ala
- Short columella
- Abnormal dentition
- Specific articulation errors
- Resonance affected
Cleft palate
Image
Cleft palate with Pierre Robin sequence
Image
Bilateral complete cleft lip and palate
Image
Fistula
Palatal (oronasal) fistula
Image
Clefts of the Secondary Palate:Effects on Structure and Function
Structure
- Absent _____
- Altered insertion of the ________(cleft muscles of Veau)
- Abnormalities in _____
Function
- ______ insufficiency (speech and resonance affected)
- _______problems and ____regurgitation
- _______malfunction
- velar aponeurosis
- levator velar muscles
- nasal septum
function
- Velopharyngeal
- Feeding; nasal
- Eustachian tube
Submucous Cleft Palate:Types and Severity
Overt—
Occult (hidden)—
visible from the oral surface
normal on the oral surface, abnormal on the nasal surface
**Classic stigmata of an overt submucous cleft:
Bifid or hypoplastic:
Zona pellucida—
Notch in the hard palate where the posterior nasal ____should be, if the submucous cleft extends that far
Muscles often affected in the same way as a ______palate
Bifid or hypoplastic:(small and underdeveloped) uvula
Zona pellucida—thin, bluish area in middle of the velum
spine
complete cleft
Submucous Cleft Palate
Image
Submucous Cleft:
Affects ______of the_______muscle
Levator muscle inserts on the _____ border of hard palate rather than in the middle of the velum
interdigitation and levator veli palatini
posterior
(Image)
Submucous Cleft: Effects on Structure and Function
Depends on the ____
May have virtually no ____
May have the same effects as an overt cleft palate as follows:
Structure
Altered insertion of the ________ (cleft muscles of Veau)
extent
effect
levator velar muscles
Function
Velopharyngeal ______(speech and resonance affected)
Feeding _____and nasal regurgitation
Eustachian tube ______
Insufficiency
problems
malfunction
Clefts of the Primary Palate:Types and Severity
Midline cleft with holoprosencephaly
Holoprosencephaly—
failure of the prosencephalon (the embryonic forebrain) to divide into double lobes of the cerebral hemispheres. The result is a single-lobed brain structure.
Image
Facial Clefts: Type and Severity
Can be caused by:
Genetic defects
Amniotic bands
Two types of facial clefts:
Oblique
Midline (median)
Facial Clefts: Effects on Structure and Function
Structural abnormalities on the outside the head (face or skull) usually suggest abnormalities on _________(face or skull).
the inside of the head
Abnormalities on the inside the head (face or skull) usually affect function of the following:
cognition language speech resonance hearing feeding/swallowing
Prevalence of Clefts***
Cleft lip occurs twice as often in ____(with/without cleft palate).
Cleft palate occurs twice as often in ______.
males
females
Submucous cleft
Facial cleft
Essentially unknown
May not cause problems with speech
May become symptomatic after adenoidectomy
very rare
Treatment of Clefts
Cheiloplasty to close the lip
Palatoplasty to close the palate
Usually pharyngeal flap or sphincter pharyngoplasty if there is velopharyngeal insufficiency affecting speech
Clefts are a common _________
Proper intervention is important.
birth defect.
Velopharyngeal insufficiency*
VP closure is not achieved due to an anatomical
In cleft palate, this is what we are talking about**
VP incompetency*
results from a functional problem
VP mislearning*
person incorrectly learns how to use sounds; anatomy and function are fine
