Cleft Lip and Palate

Question 1

at what week does fusion of facial structures occur?

Answer 1

week 7

Question 2

cleft lip is due to failure of what?

Answer 2

fusion between median nasal process and maxillary process

Question 3

patients with cleft lip with or without cleft palate have their lip/alveolus contiguous without what?

Answer 3

any vestibule

Question 4

what is involved in patients with cleft lip with or without cleft palate?

Answer 4

dental lamina

Question 5

incidence of cleft lip with or without cleft palate in WHITE population

Answer 5

1:1000

Question 6

incidence of cleft lip with or without cleft palate in African American population

Answer 6

1:2000

Question 7

incidence of cleft lip with or without cleft palate in Asian population

Answer 7

1:500

Question 8

incidence of cleft lip with or without cleft palate in males vs females

Answer 8

2 M: 1 F

Question 9

incidence of cleft lip with or without cleft palate occurring on left vs right

Answer 9

2 left: 1 right

Question 10

incidence of isolated cleft palate

Answer 10

1:2000

Question 11

incidence of isolated cleft palate in females vs males

Answer 11

2 F: 1 M

Question 12

racial predilection in patients with isolated cleft palate

Answer 12

none

Question 13

etiology of clefting

Answer 13

1. environmental

2. genetic

Question 14

environmental etiologies of clefting

Answer 14

1. socioeconomic
2. maternal illness
3. medications
4. maternal age

Question 15

percent of 2 non-cleft parents and 1 cleft child?

Answer 15

4%

Question 16

percent of 1 cleft parent and no cleft child?

Answer 16

7%

Question 17

percent of 1 cleft parent and 1 cleft child?

Answer 17

17%

Question 18

cleft palate team consists of whom?

Answer 18

1. pediatrictian
2. plastic surgeon
3. OMFS
4. pediatric dentist
5. orthodontist
6. speech pathologist
7. geneticist
8. social service counseling

Question 19

primary care of cleft child

Answer 19

1. early consult with surgeon
2. family counseling
3. feeding
4. middle ear disease
5. other medical problems

Question 20

feeding for cleft child

Answer 20

1. modified nipple

2. breast feeding

Question 21

what percent of cleft babies have cardiac problems?

Answer 21

10%

Question 22

rule of “tens” for lip repair on cleft child

Answer 22

1. 10 weeks of age
2. 10 lbs
3. hemoglobin >10
4. WBC <10
5. orthodontic molding of segments

Question 23

orthodontic molding of segments

Answer 23

“bandaid traction”

Question 24

palate repair of cleft child

Answer 24

soft tissue closure of palatal defect

Question 25

what age can a cleft child get their palate repair?

Answer 25

12 months

Question 26

what is the most critical driving force for palate repair?

Answer 26

speech

Question 27

what is common with palate repairs?

Answer 27

residual fistula at anterior of palate and in vestibule

Question 28

T/F: speech evaluation/therapy is ongoing throughout child's life

Answer 28

true

Question 29

why is speech evaluation/therapy ongoing throughout a cleft child's life?

Answer 29

nasal speech is a problem

Question 30

what is secondary to velopharyngeal incompetence?

Answer 30

nasal airway remains open during speech and air escapes

Question 31

how is speech evaluated?

Answer 31

by nasopharyngoscopy, or nasal airflow studies

Question 32

good chairside screening of speech evaluation/therapy is what?

Answer 32

"mirror test"

Question 33

what may improve with speech evaluation/therapy?

Answer 33

velopharyngeal flap

Question 34

velopharyngeal flap

Answer 34

attaches part of soft palate to posterior wall of pharynx

Question 35

how can cleft child eliminate nasal speech?

Answer 35

narrow airway so child can learn to close off during speech

Question 36

what might fixing velopharyngeal incompetence to competence lead to?

Answer 36

1. mouth breathing | 2. OSA

Question 37

velopharyngeal flap complicates what?

Answer 37

intubation for surgery, particularly when nasal intubation is needed for orthognathic surgery

Question 38

indications for alveolar bone graft

Answer 38

1. produce continuous arch for stability 2. improve osseous support of teeth adjacent to cleft 3. allow bone for maxillary cuspid to erupt into 4. support ala of nose 5. close oronasal fistula

Question 39

primary alveolar bone graft

Answer 39

<2 years old

Question 40

early secondary alveolar bone graft

Answer 40

2-5 yrs

Question 41

early mixed dentition secondary alveolar bone graft

Answer 41

prior to eruption of lateral incisor: 6-8

Question 42

late mixed dentition secondary alveolar bone graft

Answer 42

prior to eruption of cuspid: 8-12

Question 43

late secondary alveolar bone graft

Answer 43

after eruption of cuspid: >12

Question 44

what is the most commonly selected time for alveolar bone graft?

Answer 44

mixed dentition grafting

Question 45

what does mixed dentition grafting allow?

Answer 45

allows grafting in conjunction with tooth eruption which produces best bone form

Question 46

if lateral incisor is present, particularly if in distal segment, when should grafting be considered?

Answer 46

early

Question 47

if lateral is absent, or pt is small, or cleft is large, when should grafting be considered?

Answer 47

delay until later