Cleft Lip And Palate

Question 1

What is cleft lip and palate?

Answer 1

Congenital deformities involving full-thickness defects of the upper lip and/or palate.

Question 2

What is the incidence of cleft lip and palate worldwide?

Answer 2

Approximately 1 in 1000 live births.

Question 3

What is the incidence of isolated cleft palate?

Answer 3

Approximately 1 in 2000 live births.

Question 4

Which gender is more commonly affected by cleft lip?

Answer 4

Males.

Question 5

Which gender is more commonly affected by isolated cleft palate?

Answer 5

Females.

Question 6

What is the most common orofacial congenital defect?

Answer 6

Cleft lip and palate.

Question 7

What is the most common side affected in unilateral cleft lip?

Answer 7

Left side.

Question 8

What are the main causes of cleft lip and palate?

Answer 8

Genetic, environmental, and multifactorial factors.

Question 9

What environmental factors contribute to cleft lip and palate?

Answer 9

Smoking, viral infections, certain medications, radiation, poor nutrition, alcohol, pesticides.

Question 10

What is the embryological origin of the face?

Answer 10

Frontonasal, maxillary, and mandibular prominences.

Question 11

At what gestational age does facial development occur?

Answer 11

Between 4 and 10 weeks of gestation.

Question 12

What causes cleft lip?

Answer 12

Failure of fusion between the medial nasal and maxillary prominences.

Question 13

What causes cleft palate?

Answer 13

Failure of the palatal shelves to fuse in the midline.

Question 14

What are the primary components of the hard palate?

Answer 14

Palatine process of maxilla and palatine bone.

Question 15

What are the muscles of the soft palate?

Answer 15

Levator veli palatini, tensor veli palatini, palatoglossus, palatopharyngeus, musculus uvulae.

Question 16

What syndromes are commonly associated with cleft lip and palate?

Answer 16

Van der Woude syndrome, Velocardiofacial syndrome, Pierre Robin sequence, Stickler syndrome.

Question 17

What is Pierre Robin sequence?

Answer 17

Micrognathia, glossoptosis, respiratory distress, and cleft palate.

Question 18

What are the classifications of cleft lip?

Answer 18

Unilateral/bilateral, complete/incomplete, syndromic/non-syndromic.

Question 19

What classification system is used for cleft palate?

Answer 19

Kernahan and Stark’s striped-Y classification.

Question 20

What cardiac abnormalities are associated with cleft lip and palate?

Answer 20

Congenital heart defects such as those in Velocardiofacial syndrome.

Question 21

What are some feeding problems associated with cleft lip and palate?

Answer 21

Difficulty with suction, nasal regurgitation, recurrent chest infections.

Question 22

What are common speech problems in cleft palate patients?

Answer 22

Hypernasality, articulation disorders, velopharyngeal insufficiency.

Question 23

What investigations are done before cleft palate repair?

Answer 23

FBC, EUCr, viral screening, throat swab, chest X-ray, skull X-ray, ECG/ECHO.

Question 24

What imaging modality can detect cleft lip prenatally?

Answer 24

Prenatal ultrasound.

Question 25

What is the 'rule of 10' for cleft lip surgery?

Answer 25

10 weeks old, 10 pounds weight, hemoglobin of at least 10 mg/dL, WBC <10,000 cells/cc.

Question 26

At what age is cleft lip repair typically performed?

Answer 26

3 to 6 months of age.

Question 27

At what age is cleft palate repair typically performed?

Answer 27

9 to 18 months of age.

Question 28

What is the goal of presurgical orthopedics in cleft lip and palate?

Answer 28

To align maxillary segments, reposition nasal cartilage, and improve surgical outcomes.

Question 29

What are common presurgical orthopedic techniques?

Answer 29

Taping, nasoalveolar molding (NAM).

Question 30

What are the principles of cleft lip repair?

Answer 30

Restore anatomical continuity, proper muscle alignment, precise skin repair, nasal integrity.

Question 31

What are common surgical techniques for cleft lip repair?

Answer 31

Millard’s rotation-advancement technique, Tennison-Randall triangular flap method.

Question 32

What layers are repaired in cleft lip surgery?

Answer 32

Mucosa, muscle, and skin.

Question 33

What type of anesthesia is used for cleft palate surgery?

Answer 33

General anesthesia with armored endotracheal tube and throat packing.

Question 34

What surgical techniques are used for hard palate repair?

Answer 34

Bardach, Veau-Wardill-Kilner V-Y pushback palatoplasty, Von Langenbeck technique.

Question 35

What surgical techniques are used for soft palate repair?

Answer 35

Furlow’s double-opposing Z-plasty, intravelar veloplasty.

Question 36

What are key considerations in post-operative care for cleft lip repair?

Answer 36

Airway monitoring, pain management, feeding modifications, wound care.

Question 37

What are key considerations in post-operative care for cleft palate repair?

Answer 37

Airway monitoring, feeding restrictions, speech therapy, avoidance of hard foods.

Question 38

What are early complications of cleft palate repair?

Answer 38

Airway compromise, bleeding, dehydration, wound dehiscence.

Question 39

What are late complications of cleft palate repair?

Answer 39

Palatal fistula, speech issues, malocclusion, midface hypoplasia.

Question 40

What therapy is essential for speech development after cleft palate repair?

Answer 40

Speech therapy.

Question 41

What role does orthodontics play in cleft patients?

Answer 41

Aligns teeth and corrects maxillary growth abnormalities.

Question 42

Why is a multidisciplinary approach important in cleft care?

Answer 42

To optimize functional and aesthetic outcomes through coordinated care.

Question 43

What psychological challenges do cleft patients face?

Answer 43

Low self-esteem, social stigma, communication difficulties.

Question 44

What is Velocardiofacial syndrome?

Answer 44

22q11 deletion syndrome associated with cardiac defects, cleft palate, and facial abnormalities.

Question 45

What is the most significant risk factor for cleft lip and palate in familial cases?

Answer 45

Both parents being affected (60% recurrence risk).

Question 46

What is the most significant environmental risk factor for cleft lip and palate?

Answer 46

Maternal smoking during pregnancy.

Question 47

What is a palatal fistula?

Answer 47

A persistent opening between the oral and nasal cavities after cleft palate repair.

Question 48

How is a palatal fistula treated?

Answer 48

Secondary surgical repair, tissue grafting.

Question 49

What is the most critical factor for a successful cleft repair?

Answer 49

Proper surgical technique and post-operative care.

Question 50

What genetic mutation is associated with Van der Woude syndrome?

Answer 50

Mutation in the IRF6 gene.

Question 51

How does folic acid deficiency contribute to cleft development?

Answer 51

It increases the risk of neural crest cell defects, leading to incomplete facial fusion.

Question 52

What is the most common cause of midface hypoplasia in cleft patients?

Answer 52

Scarring and growth restriction after cleft palate repair.

Question 53

How does cleft lip affect nasal anatomy?

Answer 53

Alar base displacement, nasal rim distortion, and vestibular lining deficiency.

Question 54

What is the best feeding method for cleft palate infants?

Answer 54

Specialized cleft feeding bottles and techniques to reduce nasal regurgitation.

Question 55

Why is audiology assessment important in cleft palate patients?

Answer 55

To detect hearing loss due to Eustachian tube dysfunction.

Question 56

What is the role of nasoalveolar molding (NAM)?

Answer 56

To reshape the maxillary segments and reduce the severity of the cleft before surgery.

Question 57

What are the key principles of scar management in cleft lip repair?

Answer 57

Meticulous closure, minimal tension, and appropriate post-operative care.

Question 58

What is the function of the levator veli palatini muscle?

Answer 58

Elevates the soft palate for speech and swallowing.