Cleft Lip and Palate Flashcards
risk factors for cleft lip and palate
maternal use of teratogens (anticonvulsants and retinoic acid)
maternal smoking and alcohol ingestion
folic acid deficiency
genetic status with higher incidence of clap
both normal, 2 affected children
one parent affected, 1 child affected
formation of the lips and nose starts at ___ weeks and ends at __ weeks
direction of the fusion is ___
starts at 5 weeks, ends at 10 weeks
direction: superior to inferior
what is a cleft lip
- orbicularis oris inserts into the floor of the nose instead of forming a complete ring
t/f a patient can have a cleft nose with an intact lip
false, superior to inferior fusion leads to formation of intact floor of nose with cleft of the lip
complete vs incomplete cleft lip
complete: affects the entire lip and extends up to the nose (problem is around 5th week)
incomplete: nose is already formed, only a portion of the lip is affected (problem 8-9th week)
formation of the palate starts at __ weeks and ends at __ weeks
direction of the fusion is __
starts at 7 weeks, ends at 10 weeks
direction is anterior to posterior
what is a cleft palate
- muscles of the soft palate insert on the posterior portion of the hard palate instead of interdigitating at the palatine aponeurosis (midline)
t/f you can have a patient with an intact soft palate, but cleft hard palate
false, the direction of the closure is ant-post. a patient can have an intact hard palate, but cleft soft palate
complete vs incomplete cleft palate
complete: problem at 7th week
incomplete: problem at 8-9th week
what does LAHSHAL stand for
lip right alveolar ridge right hard palate right soft palate hard palate left alveolar ridge left lip left
clap grading
1 = 1/3 cleft
2 = 2/3 cleft
3 - complete cleft
thallwitz lip grading
L/L0 no defect
L1 notch up to the vermillion
L2 between L1 and L3
L3 up to the nost
thallwitz alveolar ridge grading
A/A0 no defect
A1 involves the alveolar ridge but not the pre-maxilla
A2 involved pre-maxilla anterior to incisive foramen
A3 reaches the incisive foramen
thallwitz hard palate grading
H/H0 no defect
H1 notch from the maxillary tuberosity or 3rd molar
H2 reaches 2/3 of the way to the incisive foramen
H3 reaches the incisive foramen
thallwitz soft palate grading
S/S0 no defect
S3 entire soft palate until maxillary tuberosity or 3rd molar (hard palate cleft = always S3)
associated problems with clap
- feeding (cannot generate negative pressure, food goes up the nose)
- speech
- dental problems
- otologic-OME or AOM (due to soft palate cleft)
- psychological
affected muscle that causes OME or AOM
tensor veli platini muscle
device that can assisst the feeding of patient with clap
feeding plate or obturator
roles of feeding obturator
- helps in closing palatal/ alveolar defect
separates oral and nasal cavity at the area of the HARD PALATE - generates negative pressure
- increased weight
- aids in breathing and speech
t/f feeding obturators can be used in isolated cleft lip or isolated soft palate defects
false, soft palate cannot be obturated because baby will not ba able to breathe due to lack of mobility of soft palate. gag reflex will be stimulated
what is cheiloplasty
- repair of cleft lip
- for improvement of feeding
- prevents widening of alveolar cleft
timing of cheiloplasty
rule of tens: 10(-12) weeks of age, 10 pounds, hemoglobin 10 g
what is palatoplasty
- repair of the clefts of the hard and soft palate
- separates oral and nasal cavity
- constructs watertight velopharynx or soft palate
- development of aesthetic dentition
- functional occlusion
- preservation of facial growth
timing of palatoplasy
- 12 mos but before 2 yo
- too early: interferes with facial growth
- loo late: leasd to speech impairment
