Cleft Lip And Palate Flashcards
What is cleft lip and palate?
Congenital deformities involving full-thickness defects of the upper lip and/or palate.
What is the incidence of cleft lip and palate worldwide?
Approximately 1 in 1000 live births.
What is the incidence of isolated cleft palate?
Approximately 1 in 2000 live births.
Which gender is more commonly affected by cleft lip?
Males.
Which gender is more commonly affected by isolated cleft palate?
Females.
What is the most common orofacial congenital defect?
Cleft lip and palate.
What is the most common side affected in unilateral cleft lip?
Left side.
What are the main causes of cleft lip and palate?
Genetic, environmental, and multifactorial factors.
What environmental factors contribute to cleft lip and palate?
Smoking, viral infections, certain medications, radiation, poor nutrition, alcohol, pesticides.
What is the embryological origin of the face?
Frontonasal, maxillary, and mandibular prominences.
At what gestational age does facial development occur?
Between 4 and 10 weeks of gestation.
What causes cleft lip?
Failure of fusion between the medial nasal and maxillary prominences.
What causes cleft palate?
Failure of the palatal shelves to fuse in the midline.
What are the primary components of the hard palate?
Palatine process of maxilla and palatine bone.
What are the muscles of the soft palate?
Levator veli palatini, tensor veli palatini, palatoglossus, palatopharyngeus, musculus uvulae.
What syndromes are commonly associated with cleft lip and palate?
Van der Woude syndrome, Velocardiofacial syndrome, Pierre Robin sequence, Stickler syndrome.
What is Pierre Robin sequence?
Micrognathia, glossoptosis, respiratory distress, and cleft palate.
What are the classifications of cleft lip?
Unilateral/bilateral, complete/incomplete, syndromic/non-syndromic.
What classification system is used for cleft palate?
Kernahan and Stark’s striped-Y classification.
What cardiac abnormalities are associated with cleft lip and palate?
Congenital heart defects such as those in Velocardiofacial syndrome.
What are some feeding problems associated with cleft lip and palate?
Difficulty with suction, nasal regurgitation, recurrent chest infections.
What are common speech problems in cleft palate patients?
Hypernasality, articulation disorders, velopharyngeal insufficiency.
What investigations are done before cleft palate repair?
FBC, EUCr, viral screening, throat swab, chest X-ray, skull X-ray, ECG/ECHO.
What imaging modality can detect cleft lip prenatally?
Prenatal ultrasound.
What is the ‘rule of 10’ for cleft lip surgery?
10 weeks old, 10 pounds weight, hemoglobin of at least 10 mg/dL, WBC <10,000 cells/cc.
At what age is cleft lip repair typically performed?
3 to 6 months of age.
At what age is cleft palate repair typically performed?
9 to 18 months of age.
What is the goal of presurgical orthopedics in cleft lip and palate?
To align maxillary segments, reposition nasal cartilage, and improve surgical outcomes.
What are common presurgical orthopedic techniques?
Taping, nasoalveolar molding (NAM).
What are the principles of cleft lip repair?
Restore anatomical continuity, proper muscle alignment, precise skin repair, nasal integrity.
What are common surgical techniques for cleft lip repair?
Millard’s rotation-advancement technique, Tennison-Randall triangular flap method.
What layers are repaired in cleft lip surgery?
Mucosa, muscle, and skin.
What type of anesthesia is used for cleft palate surgery?
General anesthesia with armored endotracheal tube and throat packing.
What surgical techniques are used for hard palate repair?
Bardach, Veau-Wardill-Kilner V-Y pushback palatoplasty, Von Langenbeck technique.
What surgical techniques are used for soft palate repair?
Furlow’s double-opposing Z-plasty, intravelar veloplasty.
What are key considerations in post-operative care for cleft lip repair?
Airway monitoring, pain management, feeding modifications, wound care.
What are key considerations in post-operative care for cleft palate repair?
Airway monitoring, feeding restrictions, speech therapy, avoidance of hard foods.
What are early complications of cleft palate repair?
Airway compromise, bleeding, dehydration, wound dehiscence.
What are late complications of cleft palate repair?
Palatal fistula, speech issues, malocclusion, midface hypoplasia.
What therapy is essential for speech development after cleft palate repair?
Speech therapy.
What role does orthodontics play in cleft patients?
Aligns teeth and corrects maxillary growth abnormalities.
Why is a multidisciplinary approach important in cleft care?
To optimize functional and aesthetic outcomes through coordinated care.
What psychological challenges do cleft patients face?
Low self-esteem, social stigma, communication difficulties.
What is Velocardiofacial syndrome?
22q11 deletion syndrome associated with cardiac defects, cleft palate, and facial abnormalities.
What is the most significant risk factor for cleft lip and palate in familial cases?
Both parents being affected (60% recurrence risk).
What is the most significant environmental risk factor for cleft lip and palate?
Maternal smoking during pregnancy.
What is a palatal fistula?
A persistent opening between the oral and nasal cavities after cleft palate repair.
How is a palatal fistula treated?
Secondary surgical repair, tissue grafting.
What is the most critical factor for a successful cleft repair?
Proper surgical technique and post-operative care.
What genetic mutation is associated with Van der Woude syndrome?
Mutation in the IRF6 gene.
How does folic acid deficiency contribute to cleft development?
It increases the risk of neural crest cell defects, leading to incomplete facial fusion.
What is the most common cause of midface hypoplasia in cleft patients?
Scarring and growth restriction after cleft palate repair.
How does cleft lip affect nasal anatomy?
Alar base displacement, nasal rim distortion, and vestibular lining deficiency.
What is the best feeding method for cleft palate infants?
Specialized cleft feeding bottles and techniques to reduce nasal regurgitation.
Why is audiology assessment important in cleft palate patients?
To detect hearing loss due to Eustachian tube dysfunction.
What is the role of nasoalveolar molding (NAM)?
To reshape the maxillary segments and reduce the severity of the cleft before surgery.
What are the key principles of scar management in cleft lip repair?
Meticulous closure, minimal tension, and appropriate post-operative care.
What is the function of the levator veli palatini muscle?
Elevates the soft palate for speech and swallowing.
