Cleft Lip and Palate Flashcards
What is the male:female ratio for isolated cleft palate
0.0430555555555556
What is the male:female ratio for cleft lip, with or without cleft palate
0.0840277777777778
When is cleft palate repair performed
>6 months.
What is the incidence of cleft lip, with or without cleft palate, in term newborns
1 in 1000.
When is lip adhesion performed
2 - 4 weeks of age.
When does the primary palate develop
4 - 5 weeks gestation.
At what age is pharyngoplasty typically performed
4 years.
What is the chance of producing a cleft-lipped child when one parent is affected
4%.
When does the secondary palate develop
8 - 9 weeks gestation.
What % of children with cleft palate do not require tympanostomy tubes
8 - I 0°/o.
What is the most common facial cleft
A cleft uvula.
What is the difference between a complete cleft of the primary palate and that of the secondary palate
A complete cleft of the primary palate extends into the nose, is always associated with a cleft lip, and does not expose the vomer. A complete cleft of the secondary palate involves both the hard and soft palates, extends into the nose, and exposes the vomer.
What are the key features of the Millard cleft lip repair
A medial rotation flap to align the vermillion, a triangular C flap to lengthen the columella and an advancement flap to close the upper lip and nostril sill.
What is the role of palatal plates in the treatment of cleft palates
A palatal plate, when worn for 3 months prior to surgery and adjusted weekly to bring the palate and alveolus into a more normal shape, has been shown to lessen closure tension during surgery.
What is lip adhesion
A preliminary step in cleft lip repair where a complete cleft lip is converted into an incomplete cleft.
What is an incomplete cleft
A varying amount of midline mucosal attachment is preserved with an underlying muscular deficiency.
What is the most important factor in the aesthetic outcome of lip reconstruction
Alignment of the vermillion border.
How does the secondary palate develop
As a medial ingrowth of the lateral maxillae with fusion in the midline.
How does the primary palate develop
As a mesodermal and ectodermal proliferation of the frontonasal and maxillary processes.
At which points is the normal vermillion the widest
At the peaks of Cupid’s bow.
When is alveolar bone grafting typically performed
Between ages 9 and I I.
What further facial deformities often occur as a child with a cleft palate grows
Collapse of the alveolar arch, midface retrusion, and malocclusion.
What sounds are most difficult for patients with cleft palate
Consonants, as they require full palatal lift.
What is the primary disadvantage of lip adhesion
Creates scar tissue that can interfere with definitive repair.
What is the significance of the timing of palatal repair on midfacial growth and speech
Earlier repair is associated with better speech but midface retrusion; later repair is associated with worse speech but minimal midface retrusion. More evidence exists to support the importance of timing on speech than on midface retrusion.
Which ethnic group has the highest incidence of isolated cleft palate
Equal incidence among racial groups.
T/F: A cleft lip is always associated with a cleft alveolus
False; but a cleft alveolus is always associated with a cleft lip.
For which types of clefts is the double reversing Z-plasty best
For narrow soft palate clefts and submucous clefts.
What are the boundaries of a unilateral cleft of the primary palate
From the incisive foramen anteriorly, between the canine and adjacent incisor to the lip.
What disorder should be suspected in children with cleft palate who fall below the 5t h percentile in growth
Growth hormone deficiency, as it is 40 times more common in this population.
What is the incidence of isolated cleft palate in term newborns
I in 2000.
When does midface retrusion present in children with cleft palate
In the teenage years when the growth spurt occurs.
What divides the palate into the primary and secondary palates
Incisive foramen.
What type of cleft is a submucous cleft palate
Incomplete cleft of the secondary palate.
What is the characteristic nasal deformity in a child with a unilateral cleft lip
Inferior and posterior displacement of the alar cartilage on the cleft side.
What are the indications for pharyngoplasty after cleft palate repair
Intractable VPI not responsive to speech therapy.
What is the term for repair of the levator veli palatini muscle during cleft palate repair
Intravelar veloplasty.
What are the major advantages of the Millard repair
It preserves cupid’s bow and the philtral dimple, and by placing the tension of closure under the alar base, it reduces flare and promotes improved molding of the underlying alveolar process.
During embryologic development, what causes a cleft lip
Lack of mesodermal proliferation results in an incomplete epithelial bridge.
What artery runs through the incisive foramen
Lesser palatine artery.
What structures form the hard palate
Maxilla, horizontal process of the palatine bone, and the pterygoid plates.
How is midface retrusion treated
Maxillary advancement through LeFort osteotomies.
What happens to the soft palate muscles in a secondary cleft palate
Muscle fibers follow the cleft margins and insert into the posterior edge of the remaining soft palate.
What happens to the orbicularis oris muscle in a complete cleft lip
Muscle fibers follow the cleft margins and tenninate at the alar base.
What happens to the orbicularis oris muscle in an incomplete cleft lip
Muscle fibers remain continuous but are hypoplastic across the cleft.
Which ethnic group has the highest incidence of cleft lip
Native Americans.
What muscles form the soft palate
Palatopharyngeus, salpingopharyngeus, levator and tensor veli palatini, muscular uvula, palatoglossus, and superior constrictor muscles.
What are the most common environmental causes for clefts
Poorly controlled maternal diabetes and amniotic band syndrome.
What is usually the last surgery performed in children with clefts
Rhinoplasty.
Feeding difficulties are most severe with which type of cleft
Secondary palate clefts (either isolated or in combination with clefts of the lip and primary palate).
What strategies can be used to assist feeding with a cleft palate
Specialized nipples, upright feeding to minimize nasal regurgitation, palatal plates.
What was the first approach described for cleft lip repair
Straight line closure.
What are the 3 techniques most often used for unilateral cleft lip repair
Straight line repair, Tennison triangular flap repair, and Millard rotation advancement flap.
What are 2 techniques for pharyngoplasty
Superior based pharyngeal flap and sphincter pharyngoplasty.
What muscle is primarily responsible for preventing velopharyngeal insufficiency
Superior constrictor muscle.
What is Simonart’s band
The bridge of tissue connecting the central and lateral lip in an incomplete cleft lip.
In a Millard repair, which part of the lip is rotated and which is advanced
The medial segment is rotated inferiorly, and the lateral segment is then advanced medially.
What are the 2 most common methods of secondary cleft palate repair
The V-Y advancement and the double reversing Z-plasty.
Which is best for clefts extending into the hard palate
The V-Y advancement.
What is the purpose of lip adhesion
To facilitate definitive repair by decreasing the tension across the wound.
What is the most common single gene transmission error causing clefts
Trisomy 21.
T/F: At no time in the development of the normal primary palate is there a separation
True.
What is the most common repair for complete unilateral cleft palate
Two flap palatoplasty, described by Bardach and Slayer.
What % of patients eventually require pharyngoplasty to reduce VPI
Up to 20%.
What are the 2 most commonly used classification systems for clefts
Veau and Iowa classifications.
When is a cleft lip normally repaired
When the child is I 0 weeks old, weighs I 0 lbs, and has a hemoglobin of I 0 (“rule of I O’s”); this is delayed 4 months if lip adhesion is first performed.
