Cleft Surgical Repair

Question 1

Dangers of surgical repair

Answer 1

Disruption of blood supply, nerve supply & growth

Question 2

Lip repair

Answer 2

-lip repair can contribute to nasal obstructions if it results in stenosis of the nasal vestibule. This obstruction can cause problems with nasal breathing and sleep, and even cause abnormal resonance

Question 3

Anesthesia Rule

Answer 3

Rule of 10s
10 lbs
10 weeks
10 g of hemoglobin (O2 in the blood)

Question 4

NAM

Answer 4

Nasal-Alveolar Molding- other procedures for bringing the cleft segments closer together

Question 5

Lip Repair Types

Answer 5

Straight line repair
Triangular flap repair/Tennison-Randall
Millard rotation advancement technique
(both designed for unilateral and bilateral cleft lip repair)

Question 6

Fistulae

Answer 6

holes that develop after surgical repair, the tissue dehisces.
Functional= fistulae has effect on speech, eating or drinking, if air, food or liquid gets into the nose
Cannot impound oral pressure with fistulae

Question 7

What type of repair is the primary palate/hard palate?

Answer 7

Soft tissue repair

Question 8

What are the important muscles under the palate?

Answer 8

Palatal glossus

Palatal pharyngeous

Question 9

One-Stage Palate Repairs

Answer 9

done around 10-24 months of age
furlow z-plasty for the soft palate
Von Langenbeck
V-Y retroposition procedure/Wardill Pushback Procedure
Vomer Flap

Question 10

Two-Stage Palate Repairs

Answer 10

done around 12 months and then 24 months

Risks of 2 surgeries

Question 11

Orthognathic Surgery

Answer 11

Oro-maxillofacial surgeon
Bone graft to the alveolus (if there was a cleft in the alveolus)
Surgery should be done when adult teeth are starting to grow in, between 6-10 years old
Goal: good blood supply, teeth to grow
If fistulae, this will also be addressed during surgery
Donor site is usually bone graft from the iliac crest in the hip

Question 12

Maxillary Osteotomy

Answer 12

Oro-maxillary surgeon (except Le Fort 3- plastic surgeon and cranial surgeon)
Le Fort Osteotomy is upper jaw surgery that involves sectioning and repositioning maxilla to correct its abnormal position/retruded, midface hypoplasia
Main goal: realign occlusion
Advantage: makes a big difference to the child’s profile
Complications: infections, however very successful. Some lifestyle restrictions.
Maxillary advancement can create VPI/dysfunction
Le Fort 1: Upper jaw line
Le Fort 2: Bridge of the nose
Le Fort 3: Orbit if the eyes, exposes brain at orbit of eye

Question 13

Mandibular Osteotomy

Answer 13

“Spreaders”. Changes the length of the mandible (usually done to shorten mandible for kids with cleft palate)
A cut is made through the gum behind the back teeth to gain access to the jawbone. The lower jaw is then cut with a small saw to allow it to be broken in a controlled manner. It is then moved into its new position and held in place with small metal plates and screws.
After the procedure, the process/goal is distraction osteogenesis. This is when two segments of a bone slowly apart in such a way that new bone fills in the gap.