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cleft palate > cleft exam 3 > Flashcards

cleft exam 3 Flashcards

1
Q

primary procedures

A

dieffenbach, langenback, veau VY flap, veau-wardill-killner, wardill 4 flap, vomer flap

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2
Q

Dieffenbach 1845 SPV MDS

A
  1. Split bone laterally along alveolar ridge
  2. Pack space with cotton
  3. Vomer separated from whichever side it was attached to
  4. MM resected from edge of cleft
  5. Holes drilled in HP
  6. Shelves sewn together with silk sutures (like corset)
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3
Q

dieffenbach issues

A

a. Facial growth
b. Shelves shift like tectonic plates
c. Causes distortion and need for realignment

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4
Q

langenback 1860 RILS

A
  1. MM resected at edge of cleft
  2. Lateral incisions in MP of alveolar ridge
  3. MP lifted, loosened from bony shelf
  4. MP sutured together, velum closed off
  5. REVOLUTIONARY- no broken bone or drilling
  6. CRITICISM: open space above suture inti nasal cavity→ bacteria
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5
Q

veau VY flap

A
  1. Veau criticized the langenback for the space above suture, which allowed for infection from nasal bacteria
  2. Suggested suturing flap of MP at floor of nasal cavity
  3. Then suturing palatine flap
  4. THEN suturing the flaps together
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6
Q

veau-wardill-kilner

PARMP SNaP SPM

A
  1. Large cleft with minimal tissue
  2. Incision MP along premaxilla, alveolar ridge and midline
  3. Flaps peeled backwards, freed from bone
  4. Suture MP of nasal (veau) flap
  5. Bring two palatine flaps together, suture
  6. Suture nasal and palatine flaps,
  7. Suture anterior aspects of flap to premaxilla
  8. Hope MP will grow back to cover exposed bone
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7
Q

wardill four flap

L3ARM SN S12 S34 S1234 SNaP

A
  1. Wide cleft- need any available MP
  2. Create four flaps with incisions along:
    a. Midline
    b. 1/3 anterior to midline
    c. alveolar ridge
    d. creates two posterior and two anterior flaps
  3. close nasal MP
  4. suture flaps 1&2 together
  5. suture flaps 3&4 together
  6. suture 1&2 to 3&4
  7. suture palatine to nasal
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8
Q

vomer flap

MPV to MPP SPN

A
  1. Vomer is directly above cleft
  2. MP from vomer is peeled and brought down
  3. Attached to palatine MP→high arching palate
  4. Suture oral flap→nasal flap
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9
Q

pharyngeoplasty

A

dorrance pushback, pharyngeal flap

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10
Q

dorrance pushback

VF SPMP

A

i. Vomer flap ^
ii. Peel back palatine MP
iii. Posteriorly towards midline (diagonally)
iv. Anterior- vomer flap, oral MP
v. Posterior- palatine flap closes cleft AND lengthens palate

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11
Q

dorrance results

A

vi. NOT muscle so can’t move like true velum→ VP closure affected
vii. Immediate results
viii. Surgery fell out of favor in 60’s but is regaining popularity.

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12
Q

pharyngeal flap types

A

i. Flap from pharyngeal wall attached to posterior aspect of shortened palate/velum
v. Types
1. Pharyngeal wall Muscle M→velum MM (cleft velum?)
2. pharyngeal wall Muscle M brought in to fill cleft, sutured on either side, NO RESECTION
3. Trap door
a. Lift flap pulled up from laryngeal muscle, exposing it
b. Bring flap down from velum and attach directly to muscle

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13
Q

pharyngeal flap attachment

A

ii. Superior attachment
1. Advantages
a. Lifts velum upward and back
b. More natural
c. better speech
d. Doesn’t interfere with swallow
2. Disadvantages
a. Interfere with ET fn?
b. Adenoidectomy requires opening of flap
iii. Inferior attachment
1. Only if pharyngeal wall cant handle superior
2. Not natural, ineffective closure
3. May interfere with tongue, mouth, swallowing

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14
Q

pharyngeal flap results- Broadbent/Swinyard

A

vi. Should not cause hyponasality if flap is right size and attached correctly
vii. ADVANTAGE: Broadbent and Swinyard “pharyngeal flap is a dynamic muscular unit that can move unlike dorrance”
viii. DISADVANTAGE-
a. Painful, invasive
b. Before 6-9 mos
c. have to wait for it to heal completely (1-1.5 YEARS) before you can assess success
d. may not create adequate VPC

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15
Q

pharyngoplasty- muscle transposition-SP

A
  1. muscle pulled or moved from normal location
  2. ex- salpingopharyngeus
    a. (lateral from ET→palatopharyngeus)
    b. L and R SP pulled backward and sutured to pharyngeal wall
    c. Contraction pulls pharyngeal wall forward to contact velum
  3. creates more pharyngeal wall activity
  4. not common due to issues with swallowing, controversy
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16
Q

pharyngoplasty- orticochea

A
  1. Orticochea-
    a. same as above but palatopharyngeus
    b. back to medial wall
    c. creates more pharyngeal wall activity
    d. not common due to issues with swallowing, controversy
17
Q

implants

A

d. implants
i. everything else has failed
ii. silicone or Teflon
1. most effective
2. implanted in pharyngeal wall where velum will touch
3. increases VPC
iii. cartilage not very effective
iv. bone not effective

18
Q

lip procedures

A

Abbe flap, millard rotation advancement, thomson z-plasty, thomson quadrilateral

19
Q

lip criteria

VENUS

A

i. accurate union of tissue
ii. symmetrical nares
iii. symmetrical vermilion border
iv. slight eversion of upper lip
v. minimal scarring

20
Q

Abbe flap

A

i. Used to add tissue to upper lip
ii. cases where too much tissue was discarded in initial surgery= tight or short lip
iii. lip is flat
iv. cosmetic EXCEPT for possible effect on consonant production
v. procedure
1. incision at inferior part of upper lip and superior part of lower lip
2. sutured together to allow tissure to migrate to upper lip and fill in gap
a. does NOT repair cleft

21
Q

Millard rotation-advancement

A

i. MOST COMMON
ii. Lip is elevated on either side of cleft
iii. Rotation= lowering of cupids bow
1. Semicircular incision above normal lip to drop lip down to normal position
2. V shaped gap
iv. Advancement= movement of flap into gap
1. Then semi-rectangualar incision is make on opposite side
2. That flap does into v-shaped gap
v. Scarring

22
Q

thomson z-plasty

A

i. Z shaped scar, but heals well
ii. Triangle flap on one side
iii. V shaped incision on other
iv. Lower lips and fit together like interlocking shape

23
Q

thomson quadrilateral

A

i. Offcenter scar- ½ in philtrum, ½ outside

ii. Some do better with this type

24
Q

why surgery?

A

feeding, drinking, swallowing, speech, cosmetic appearance, dentition, audition/hearing

25
Q

Holdsworth normality of speech

A

i. 0-6 mos: 80-100%
ii. 6-9 mos: 77%
iii. 10-12 mos: 54%
iv. 16-18 mos: 22%
v. 2+years: 0%

26
Q

deadlines for surgery

A

i. lip: 5 weeks (arch collapse- keeps vomer from protruding)
ii. velum: 9 mos
iii. hard palate: 12-18 mos

27
Q

surgery prerequisites

A

i. normal size/weight gain (over 10 rule)
ii. no upper respiratory infection
iii. no pathogenic bacteria
iv. size/depth of pharynx
1. space between velum and pharyngeal wall
2. too great→ compensatory techniques

28
Q

over 10 rule

A
  1. 10 weeks (NOT TRUE FOR LIP)
  2. 10 lbs
  3. 10 hemoglobin g/100mL)

cleft palate (2 decks)

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