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xD3 Oral Surgery Ex 3 > Cleft Lip and Palate (Abubaker) > Flashcards

Cleft Lip and Palate (Abubaker) Flashcards

1
Q

What approach is indicated for the management of a pt with Cleft Lip and Palate?

A

Team approach

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2
Q

What do Tessier classifications center on when describing clefting?

A

The eye

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3
Q

What single genetic defect leading to one phenotype, which causes another genetic defect?

A

Sequence

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4
Q

What is a multiple or single genetic defect that leads to multiple phenotypes?

A

Syndrome

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5
Q

A pt that has a genetically malformed small jaw that results in an inability for the tongue to descend to the floor of themouth which results in a cleft palate has a syndrome or a sequence

A

Sequence (Pierre Robin sequence is described here)

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6
Q

What is the Pierre Robin sequence triad?

A
  1. Celft Palate
  2. Macroglossia
  3. Micrognathia
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7
Q

What percentage of cleft lip and palate patients have an associated anomaly?

A

30%

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8
Q

What is the recurrence rate of CLP in families if the first sibling has CLP?

A

Low, about 5%

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9
Q

What are the 2 populations with the highest CLP rate?

A
  1. Asians

2. Native Americans

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10
Q

What is the population with the lowest CLP rate?

A

Africans

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11
Q

Which has a higher chance of being associated with a syndrome: isolated cleft lip or isolated cleft lip or isolated cleft palate?

A

Isolated cleft palate

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12
Q

What percentage of patient with clefting have either an isolated cleft lip or an isolated cleft palate?

A

70% (this is contraindicated by info presented in the same lecture)

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13
Q

What are 2 things that increase the risk for clefting while pregnant?

A
  1. Maternal diabetes mellitus

2. Amniotic band syndrome

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14
Q

What parental characteristic increases the risk for clefting?

A

Increased paternal age

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15
Q

What percentage of clefting cases are combined Cleft Lip and Palate?

A

50%

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16
Q

What percentage of clefting cases are isolated cleft palate?

A

30%

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17
Q

What percentage of clefting cases are isolated cleft lip?

A

20%

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18
Q

What percentage of clefting cases are cleft lip and alveolus?

A

5%

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19
Q

What are the bones that make up the hard palate?

A

Palatine process of maxilla and palatine bones

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20
Q

What is the blood supply of the hard palate?

A

Greater palatine artery

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21
Q

What is the nerve supply to the hard palate?

A

Anterior palatine nerve

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22
Q

What is the fibromuscular shelf attached to the posterior portion of the hard palate, which etenses, elevates using what muscles?

A

This describes the soft palate which uses the tensor veli palatini, legator veli palatini, muscular is uvulae, palatoglossus and palatopharyngeus muscles to elevate.

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23
Q

The soft palate comes in contact with what structure on swallowing to keep food from going up into the nasopharynx?

A

Passavant’s Ridge (bulge produced during contraction of pharyngeal wall)

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24
Q

Who are the members of the cleft lip and palate team?

A
  1. Reconstructive Surgeon
  2. Otolaryngologist
  3. Oral and Maxillofacial Surgeon
  4. Pedodontist / general dentist
  5. Orthodontist
  6. Prosthodontist
  7. Audiologist
  8. Psychologist
  9. Speech pathologist
  10. Social worker
  11. Geneticist
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25
Q

True or false: with a cleft, all parts of the lip or palate are present, they simply failed to fuse in a normal way?

A

True

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26
Q

The maxillary process, lateral nasal process, and the median nasal process join and fuse to form what?

A

The primary palate

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27
Q

When is the primary palate formed?

A

Six weeks in utero

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28
Q

When does the tongue moves inferiorly allowing the lateral palatal shelves to grow towards the midline and fuse?

A

Eight weeks in utero

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29
Q

The disappearance of Medial Edge Epithelial Cells (MEEC) during embryonal prominences fusion may be due to what?

A
  1. Cell migration
  2. Cell death
  3. Epithelial to Mesenchymal transformation
30
Q

Why does fusion not take place in a cleft?

A

M E E Cells are not eliminated by the macrophages like they are supposed to be.

31
Q

What percentage of deformities is the isolated cleft lip?

A

32%

32
Q

What is the male to female ratio for clefting?

A

Males 2:1

33
Q

What percentage of cleft lip and palate are of genetic origin?

A

Less than 40%

34
Q

What percentage of isolated cleft palates are genetically derived?

A

Less than 20%

35
Q

What chance will unaffected parents with a child with cleft lip and palate have of a second child with cleft lip OR palate?

A

4.4%

36
Q

What chance will unaffected parents with a child with cleft lip and palate have of a second child with |SOLATED cleft palate?

A

2.5%

37
Q

If one parents has a cleft deformity, what is the percent chance that their first born will have a cleft lip or palate?

A

3.2%

38
Q

What are some exogenous factors implicated in clefting if taken during the first 8 weeks of pregnancy?

A
  1. Corticosteroids

2. Other drugs (Valium, Dilantin)

39
Q

When should the team evaluate the child?

A

At birth

40
Q

When does repair of the lip take place?

A

10 weeks to 3 months

41
Q

When is hearing tested?

A

6 months

42
Q

When is re-evaluation done?

A

1 year

43
Q

When is the palate repaired and myringotomy tubes done?

A

12-18 months

44
Q

When is a recall by the team performed?

A

2 years

45
Q

When are repeated hearing evaluations done?

A

2-6 years

46
Q

During what age range are interceptive orthodontics begun and erupted supernumerary teeth in the region of the cleft removed?

A

Ages 5-8

47
Q

When is a pharyngeal flap done?

A

5-7 years

48
Q

When is maxillary arch expansion done?

A

7-8 years

49
Q

When is an alveolar bone graft done?

A

9-11 years

50
Q

When is comprehensive orthodontics done?

A

12-13 years

51
Q

When is orthognathic surgery done if necessary?

A

14-16 years

52
Q

When is dental reconstruction and rhinoplasty done?

A

16-21 years

53
Q

What is the “rule of 10s” with lip repair?

A
  1. 10 weeks
  2. 10 grams of hemoglobin per dL
  3. 10 pounds
54
Q

What is the main goal of lip surgery?

A

Recreate normal anatomy

55
Q

For lip surgery to recreate normal anatomy, what three things must be accomplished?

A
  1. Preservation of “Cupid’s Bow”
  2. Reapproximation of Orbicularis Oris
  3. Minimize scarring / placement of scars in normal anatomic contours
56
Q

When do children begin to speak?

A

18 months

57
Q

When is palatal closure done?

A

12-18 months

58
Q

What is the main benefit of palatal closure?

A

Provides a normal anatomic environment for the development of normal speech

59
Q

What are two risks of palatal closure?

A
  1. Lateral crossbite due to formation of the palatal scar

2. Denuding of the periosteum

60
Q

How can the transverse problem of palatal closure usually be managed?

A

Orthodontics

61
Q

What percentage of children who undergo palatal repair at age 12-18 months develop normal speech?

A

70-80%

62
Q

For the 20-30% of children who undergo palatal repair at age 12-18 months and do not develop normal speech when will speech be assessed?

A

At age 4 or 5, before the child begins in school

63
Q

When might hyper nasal speech occur?

A

When the repaired palate is too short, and inadequate closure from the oral to nasal pharynx is present

64
Q

What is velopharyngeal insufficiency?

A

When there is inadequate closure of nasopharyngeal airway port during speech

65
Q

VPI treatment includes what?

A
  1. Speech therapy
  2. Surgical treatment (pharyngeal flaps)
  3. Prosthetic appliances
66
Q

What are the goals for alveolar cleft grafting?

A
  1. Stabilize dento-osseous segments
  2. Provide bone for eruption of the teeth
  3. Improve alveolar continuity
  4. Closure of oronasal fistula
  5. Alar base support
  6. Prevent tooth loss
67
Q

What age should the alveolar cleft grafting take place?

A
  1. Between ages 9-11, prior to the eruption of the permanent canine and after the crossbite is fixed and the incisors rotated
  2. The canine root is 2/3 formed
  3. Tooth not yet erupted
68
Q

What are 3 indications for orthognathic surgery?

A
  1. Hypoplastic maxilla and deficient face
  2. Mandibular prognathism
  3. Facial asymmetry in lower face
69
Q

What are two surgeries that are indicated in a patient with a cleft?

A
  1. Le Fort Osteotomy with advancement

2. Mandibular osteotomy (BSSO) and setback

70
Q

What are some restorative options to replace missing teeth?

A
  1. Multiple unit bridges
  2. Removable appliances
  3. Endosseous implants
71
Q

What are indications of cleft lip and palate to the GP dentist?

A
  1. Understanding the timing of procedures for explaining to a family of cleft patients
  2. Working as a cleft team member when needed
  3. Timing of restorative and prosthetic management of these patients
  4. Early referrals to specialist when needed

xD3 Oral Surgery Ex 3 (4 decks)

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