Craniofacial Midterm Flashcards
Functions of Levator Palatine and Uvulus in Velar closure
Which muscles lift the velum during swallowing and non-nasal articulation
Levator and uvulus location
Uvulus is medial to levator muscles
Nasal septum composition
Nasal bone Perpendicular plate of Ethmoid bone Quadrangular septal cartilage Vomer Anterior nasal spine
Sagittal suture
Directly behind coronal suture, down the midline. Looks like an arrow.
Coronal suture
Fuses frontal bone, side to side on anterior aspect of skull
Labdoidal suture
Fuses occipital bone to parietal bones, laterally in posterior aspect of skull
Squamosal suture
holds temporal bones to parietal bones and occipital bones
Metopic suture
Not usually visible, issue in newborns, medial line in frontal bone
Fontanelle
Anterior junction of coronal, Saggital and metopic sutures, hole in skull
Posterior structure
juction of lambdoid and sagittal sutures
Columella
Separates nares
Vermillion
Colored part of lips
Philtrum
Channel between nose and lips
Bridge
nasal bone between eyes
ala
outer rim of nare.
Cupid’s bow
upper rim of upper lip
dorsum
upper ridge of nose, immediately inferior to bridge of nose
Philtral columns
ridges bordering philtrum
Maxilla
Forms the upper jaw- in two parts during gestation, fuse to one bone at 12 weeks 5 Processes: Zygomatic Frontal Alveolar Palatine Body
Nasal bone
Forms bridge of nose.
Sphenoid
Behind face, looks like a butterfly, boom of wings support soft palate
Palatine bone
L shaped bone on either side to form football goal
Attached to maxilla
Forms posterior 25% of hard palate
Comes to point to form posterior nasal spine (PNS)
Transverse suture joins palatine bone to maxilla
Vomer
Behind nose between eyes
Forms part of nasal septum
Nasal conchae
Formed in Ethmoid bone
covered in tissue that conditions air
PNS
Posterior Nasal Spine
Palatine bone
ANS
Anterior Nasal Spine
under columella in maxilla
Fusion
Tissues approach, regress and become one.
Cells multiply faster at the tips of structures and grow towards each other.
The places that touch, regress to more primitive states that allow cells to pass back and forth which causes fusion
Merging
Filling in without regression.
Sections of tissue begin to grow faster than others, form buds and grown into other structures (arms and legs)
Less complex than fusion
Facial structures of 6 week embryo
Eyes are at 160 degrees, palate just begins forming,
Stomodeum, primitive mouth
Branchial arches, nasal pits, frontonasal process, nasolateral process, nasomedial prominence, maxillary prominences
Primary palate formation
Begins formation at 6 weeks and finishes at 7 weeks
Secondary palate formation
Begins formation at 8 weeks, finishes at 10-12 weeks
C/C 1 stage and 2 stage closure of palate.
One stage done all at once between 10 and 24 months
Two stage: 1st stage is to close velum and leave hard palate open. 2 stage closes hard palate.
To avoid detrimental effects, 2nd stage needs to take place when 1 stage would have been completed.
LeFort I, II, III
I: Moves undersized maxilla forward.
II: Moves maxilla plus bridge of nose.
III: Moves maxilla, bridge of nose, orbits and cheekbones, rare
Language development and CLP
Incidence of language disorder is unknown but higher than general population.
No specific language disorder for children with CLP
Grading tonsils
1+ Normal
2+ tonsils are even will pillars
3+ tonsils protrude past pillars
4+ tonsils touch
Waldeyers ring
Three sets of tonsils, lingual, palatine and pharyngeal
Risk factors: hypernasality and adenoidectomy
After surgery is performed to remove adenoids the patient may experience hypernasality as well as nasal regurgitation due to lack of velar closure. May be temporary of permanent VPD
Types of Malocclusion
Class I: normal with other dental anomalies
Class II: mandibular molar is even with or behind maxillary molar.
Class III: Mandibular molar is more than 1/2 tooth ahead of maxillary molar.
Normal: mandibular first molar is 1/2 tooth ahead of maxillary molar
Effect of dentition on articulation
Obligatory errors: distortion caused by structural abnormality
Compensatory errors: distortion or substitution error due to a modification in placement of tongue or lip position to compensate for the structural abnormality.
CLP and hearing acuity
High incidence of middle ear disease with CLP leads to increased HL
Incidence of CL is higher but improves with age.
Indications for adenoidectomy
Sleep apnea
Chronic Otitis media
Chronic sinusitis
Pierre Robin syndrome
Micrognathia: small jaw
Macroglossia: large tongue
Tongue does not move out of the way in utero, fetus may stay in flexion too long.
Airway management: glossopexy, NG tube, prone positioning
Associated syndromes: Stickler, VCF, FAS
VCF
Severe Hypernasality Severe articulation disorders (glottal stops) Mild language impairment VP insufficiency High pitched voice Hoarseness
Van der Woude
Paramedian pits/protuberances
Missing teeth (hypodentia) usually lateral incisors and molars
May have submucous cleft
Stickler’s Syndrome
Joints: hypermobile, arthritis Eyes: Epicanthal folds, near sightedness, cataracts, glaucoma Hears: SN HL Midface hypoplasia Vertebral anomalies Speech and language
Submucous cleft
Bifid uvula
Notching of palatine bone
Muscular diastasis (velum)
Zona Pellucida
Repair of submucous cleft
When warranted by speech errors
Effect of maxillary advancement on speech
Some studies show none.
Deterioration of VP function, hyper nasality, greater the advancement, greater the risk of hyper nasality, threshold is 10 mm. /s, f, p/ ‘sh’, ‘ch’ are most likely to change
Endoscopy before adenoidectomy
Visualize adenoids, assess risk of VPD (cleft or family history of cleft, submucous cleft, history of motor delay, nasal regurgitation or feeding difficulty, moderate-severe phonological delay, marginal VP delay
Passavant’s ridge
shelf which projects from posterior pharyngeal wall into pharynx during speech
Nasal meatus
3 passages in the nasal cavity under the nasal concha
Dysmorphology
The study of abnormal shape or form
Endogenous
Factor from organism rather than environment, genetic makeup
Zona Pellucida
Blue area in medial aspect of velum, lack of musculature, velum is thin, almost transparent
Rule of 10s
10 weeks of age
10 pounds
10 g of hemoglobin
to have cleft lip repair
Cheiloplasty
Lip reconstruction to make larger of smaller, uses neighboring tissue
Velar dimple
can be seen on oral side of velum during phonation or VP closure
Diastasis
When 2 structures that are normally joined are separated
Crossbite
Maxillary teeth are behind mandibulat teeth, can be anterior or lateral
Microtia
Small ear
palpebral fissures
opening between eyes
Hypertrophy
overgrowth of muscle
Variable expression
The variability in the expression. Disorder is very noticeable in one person and not in another
FISH
Flourescence In Situ Hybridization
Gene
unit of heredity
Phenotype
Manifestations of a genotype
Macrotia
Large ears
Corticostomy/osteotomy
Partial cut in bone to improve functionality
karyotype
quick chromosome analysis
Analyzes white blood cells
Velar knee
Hump on velum on nasal side
Kernahan’s Y
1, 4 lip 2, 5 alveolus 3, 6 alveolus to incicive foramen 7, 8 hard palate 9 soft palate
Hemifacial microsomia
One side of face is extremely small due to shortened facial bones
Craniosynostosis
Brith defect that causes one or more sutures on a baby’s head to close earlier than normal
edentulous
no teeth
open bite
upper and lower teeth are protruding, bite doesn’t close in front, thumb sucking or tongue thrust
Diastema
gap in teeth
over/underjet
Front teeth stick out at an angle
V-Y procedure
may lengthen columella if its wide enough and there’s enough upper lip
hypertolerism
narrow spaced eyes
Millard
Rotation advancement technique
More flexible, need more expertise
Pro: camouflages scar on philtral column,
Cons: vertical scar with notching of the vermillion, lower of alar base
z-plasty
Close velum and hard palate or just soft palate
Prolabium
Tissue of central upper lip that is isolated when there is a bilateral cleft
Hypertolerism
widely spaced eyes
Dehiscence
breakdown of surgical repair
Hypoplastic
Abnormality in dental enamel characterized by pits, fissures, and discoloration.
Syndrome
Pattern of multiple anomalies that occur together and are pathogenically related.
