COMPS: CLP Surgery (O5)

Question 1

What was the first type of cleft lip surgery that was performed? (It’s not usually performed anymore due to the skin not being tight and the nose being pulled down on the surgery side)

Answer 1

Straight line repair.

Question 2

How old must a baby be to have a lip repair? How much does she have to weigh? How many grams of hemoglobin in her blood must she have?

Answer 2

10 weeks
10 lbs
10 grams of hemoglobin

Question 3

What does NAM stand for and what is it?

Answer 3

Nasal Alveolar Molding- procedure to bring the cleft segments closer together

Question 4

What is the #1 thing lip repair is done for?

Answer 4

For esthetic (to make the lip look good/normal)

Question 5

List the types of lip repair.

Answer 5

1. NAM
2. Straight Line Repair
3. Triangular Flap Repair, AKA Tennison-Randall
4. Millard Rotation- Advancement Technique

Question 6

What are two cons of Straight Line Repair?

Answer 6

It pulls down the nose and nares and makes the lip look too tight; doesn’t look good.

It also impedes the growth of the maxilla.

It is no longer a commonly performed surgery.

Question 7

Name this surgery:
This surgery cuts a section on both sides of the lip and pulls the lip down. This lengthens and tightens the lips. This is potentially effective for a unilateral cleft lip.

Answer 7

Triangular Flap Repair, AKA Tennison-Randall

Question 8

Name this surgery:
This surgery is the most commonly performed cleft lip repair. It lengthens the lip and no tissue is removed, so it is not a tight repair. Most useful for bilateral cleft since no tissue is removed.

Answer 8

Millard Rotation Advancement Technique

Question 9

Cleft Palate Repair:

Name the one-stage palate repairs.

Answer 9

1. Soft Tissue Repair
2. Furlow Z-Plasty
3. Von Langenbeck Hard Palate Repair
4. V-Y Retroposition Procedure, AKA Wardill Pushback Procedure
5. Vomer Flap surgery

Question 10

Name this one-stage cleft palate surgery:

A new flap of tissue is created by bridging tissue edges together with stitching.

Answer 10

Von Langenbeck Hard Palate Repair

Question 11

Name this one-stage cleft palate surgery:

The cleft is closed by creating a flap on the nasal side to close a very large gap in the superior surface. In this surgery, it is possible to pull off tissue from the nasal turbinates.

Answer 11

Vomer Flap surgery

Question 12

Name this one-stage cleft palate surgery:

Tissue is taken from someplace else and transplanted. Problems may arise with establishing blood supply.

Answer 12

Free Flap Repair (a soft tissue repair)

Question 13

Name this one-stage cleft palate surgery:

This surgery is for the soft palate. Tissue is removed from both the nasal and oral side. This velum repair can also be a revision to lengthen the soft palate.

Answer 13

Furlow Z-Plasty for the Soft Palate

Question 14

Name this one-stage cleft palate surgery:

This surgery doesn’t involve bone graft; instead, slits are is pulled backwards. This eventually lengthens the velum.

Answer 14

V-Y Retroposition Procedure, AKA Wardill Pushback Procedure

Question 15

At what age are the two-stage palate repairs done?

Answer 15

Around 12 and 24 months.

Question 16

T/F: There are no advantages to the two-stage palate repairs.

Answer 16

True

Question 17

What is a fistula?

A functional fistula?

Answer 17

A hole that develops after surgical repair. Tissue dehiscence (death).

If a fistula has an effect on speech, eating, or drinking due to air, food, or liquid getting into the nose, the fistula is said to be functional.

Question 18

What is “orthognathic” surgery?

Answer 18

jaw surgery

Question 19

The most common and simple type of orthognathic surgery is a bone graft to the ________.

Answer 19

alveolus; this surgery is performed when there’s a cleft in the alveolus.

Question 20

T/F: After a bone graft, the bones won’t keep growing, so the timing of a graft is controversial and important.

Answer 20

True. Bone grafts of the alveolus are typically performed when facial development for adult teeth are exposed, usually around 9-10 years of age.

Question 21

What are the Le Fort Procedures?

Answer 21

A maxillary osteomy (upper jaw surgery) to correct the profile and bite. The maxilla is sectioned and repositioned.

Question 22

Name the Le Fort Procedure (maxillary osteomy):

includes both maxilla and the nasal pyramid

Answer 22

Le Fort II

Question 23

Name the Le Fort Procedure:

Includes the maxilla (alveolar arch) only

Answer 23

Le Fort I

Question 24

Name the Le Fort Procedure (maxillary osteomy):

includes maxilla, nasal pyramid, zygomas, and orbital rims; performed by a cranial surgeon.

Answer 24

Le Fort III

Question 25

What is the role of the SLP BEFORE physical management of cleft palate or craniofacial management?

Answer 25

1. Language assessment
2. NAE/hypernasality
3. Developmental errors & phonological processes
4. Endoscopic evaluation
5. Work with family to enjoy their baby & inform about typical S&L development.
6. Inform about abnormal speech sounds, teach to watch for them, and teach to praise placement even if manner isn’t correct.
7. If mechanism isn’t working, then physical management is the treatment of choice (not speech therapy)

Question 26

What is the role of the SLP AFTER physical management? (VPI surgery)

Answer 26

1. Training pt to make best of appliance or pharyngoplasty (how to use with octopus, feeling vibration, seascape)
2. Reduce NAE/hypernasality/hyponasality after appliance or surgical management.
3. Eliminating artic errors
4. Assume the surgery or obturator was a good fit.
   * give 6-8 weeks before deciding whether the physical management has worked.

Question 27

What are some speech therapy goals when working with children with cleft palate/craniofacial abnormalities?

Answer 27

1. Decrease velopharyngeal patency
2. Decrease NAE/increase oral pressure
3. Decrease hypernasality
4. Decrease compensatory errors

Question 28

What does therapy to decrease velopharyngeal patency involve?

Answer 28

• Insert endoscope and explain landmarks
• Produce phonemes that elicit closure and work to match movement of closure on correct phonemes to incorrect phonemes
• Continue using auditory feedback only

Question 29

What does therapy to decrease NAE/increase oral pressure involve?

Answer 29

• Use octopus, see-scape, mirror with fricatives, vowels, & pressure consonants
• Remove visual aids and use auditory feedback only

Question 30

What does therapy to decrease hypernasality involve?

Answer 30

• Auditory discrimination
• Visual feedback
• Tactile feedback
• Lower back of tongue
• Increase oral activity and volume through consonants (vowels low to high, short phrases with obstruents and sonorants, longer phrases, reading, structured convos)

Question 31

What does therapy to decrease compensatory errors involve?

Answer 31

• Articulation therapy for glottal/pharyngeal stops (whisper or breathy voice)
• Artic therapy for nasal fricatives (octopus or see-scape)
• Artic for pharyngeal fricatives (move production anteriorly, monitor w/ straw)
• Artic for mid-dorsum stops (tongue to lip, alveolar ridge)
• Best to conduct artic therapy early to prevent errors from occurring in the first place