Cleft lip and palate - Plastic surgery Flashcards
Clinical picture and complications in cleft lip and cleft palate?
- Cleft lip:
- Inability to form fluid or air seal in eating or speech
- Malocclusion as a result of intrinsic deformities of alveolar process and teeth.
- Lack of continuity of skin, muscle and mucous membrane of the lip with associated nasal deformity and nasal obstruction
- Deformity
- Cleft palate:
- Inability to separate nasal from oral cavity so that air and sound escape through nose in attempted speech.
- Feeding impaired by loss of sucking due to
» inability to create intra-oral negative pressure. - Loss of
» liquids and soft foods through nose due to common nasal oral chamber. - Middle ear disease in 100% of patients due to
a. Eustachian tube dysfunction,
b. abnormal mucus. - May be associated with certain syndrome, e.g.,
» Pierre Robin sequence (cleft palate, micrognathia, glossoptosis).
» In these cases, airway obstruction and failure to thrive - Abnormal facial growth
Cleft lip/palate treatment ?
A. Aim:
б to restore the continuity of the lip, nasal floor in aesthetically pleasing form.
B. Timing:
б most common at 10 weeks of age ( rule of ten → 10 weeks of age, Hgb 10, 10 Ibs )
C. Presurgical orthodontics:
б e.g., Naso-alveolar molding: help reducing the gap (especially in wide clefts) by remodeling of the alveolar processes and help feeding till the time of the operation.
D. Principles:
1. Repair of the skin, muscle, and mucosa to restore:
» continuity of the lip » symmetrical length » function
2. Simultaneous repair of both sides of a bilateral cleft lip
3. Preference of primary nasal reconstruction at the time of lip repair
Cleft palate treatment ?
A. Aim:
б to achieve adequate speech &
б dentition and competence of the velopharyngeal mechanism
B. Timing: usually 9 months of age
C. Principles:
б closure of the nasal and oral layer of the mucosa &
б restoration of the anatomy of velar muscles
