Cleft Lip and Palate

Question 1

Describe APGAR score

Answer 1

Apgar scores of 0-3 are critically low, especially in term and late-preterm infants

Apgar scores of 4-6 are below normal, and indicate that the baby likely requires medical intervention

Apgar scores of 7+ are considered normal (1, 3)

Question 2

Incidence of CLP per 1000

Answer 2

• Asian 3.2
• Caucasian 1.4
• African 0.43

Question 3

What gestational age can CLP be diagnosed

Answer 3

16 weeks via ultrasound

Question 4

What screening tool should be employed for infant with CLP

Answer 4

Echocardiogram

R/o valve disease or great vessel transposition

Question 5

CLP laterality prevalence

Answer 5

2:1 on left

Question 6

When does cleft lip (CL) develop

Answer 6

During 3rd-7th weeks

Question 7

When does cleft palate form?

Answer 7

During 5th-12th weeks

Question 8

What processes fail to fuse in CL?

Answer 8

CL = failed fusion of medial nasal and maxillary processes

Question 9

What fails to attach / align in CP?

Answer 9

CP = failed attachment and alignment of levator veli, tensor veli palatini, uvular, palatopharygeus, and palatoglossus muscles

Question 10

What forms primary palate? Secondary Palate?

Answer 10

Primary palate = premaxila = lip, alveolar arch, palate anterior to incisive foramen

Secondary palate = hard and soft palates posterior to incisive foramen

Question 11

Rule of ten’s for safe infant anesthesia

Answer 11

• 10 weeks old
• >10lbs
• Hg >10

Question 12

When is primary lip repair performed?

Advantages for later repair?

Answer 12

10-14 weeks

1. More prominent landmarks
2. Easier
   
   1. Better esthetic outcome

Question 13

When is CP repair done?

What developmental milestone guides timing?

What are advantages for later repair?

Answer 13

9-18 months

Speech development. If child has mental delay and speech is anticipated much later, than CP repair should be delayed

1. Decreased incidence of maxillary hypoplasia

Question 14

What is incidence of VPI following CP repair?

Answer 14

20% VPI

diagnosed 3-5 years old

Question 15

When is alveolar grafting performed?

Answer 15

Mixed dentition age 8-11

Canine root 2/3 formed

Question 16

When is orthognathic surgery performed

Answer 16

If needed it is done age 14-18

Question 17

When is lip and nasal revision surgery done?

Answer 17

After age 5 and only for severe deformities

Question 18

When is rhinoplasty done?

Answer 18

6-12 months after orthognathic surgery, if needed. This is because maxillary advacement often improves nasal esthetics.

Question 19

What is most common technique for unilateral CL repair?

Answer 19

Millard rotation-advancement technique

• 3 layers
• Orbicularis oris muscle is made to form continous sphincter
• Incisions lie in natural contours

https://www.youtube.com/watch?v=kVZ0vlW3c7Y

Question 20

What can be done during CL repair to lengthen columella or create nasal sill?

Answer 20

C-flap

https://www.youtube.com/watch?v=eZfQXT_A8Jo