FPRS cleft lip and palate Flashcards
Describe the embryologic development of the lip.
In the 4th week of gestation, the paired maxillary
prominences, derived from the first branchial arch, are
seen. Proliferation of mesenchyme ventral to the forebrain
gives rise to the frontonasal prominences. Nasal placodes
arise on each side of the frontonasal prominence. In week 5, invagination of the nasal placodes leads to development of
nasal pits. The medial and lateral ridges of tissue around the
pit are called the medial and lateral nasal prominences,
respectively. Between weeks 5 and 7, the medial maxillary
prominences grow medially to fuse with the medial nasal
prominences, forming the upper lip. Fusion of the medial nasal prominences leads to formation of the philtrum, medial upper lip, columella and nasal tip. The lateral upper
lip arises from the maxillary processes.
Maternal use of which medication has been linked
to a significant increase in the incidence of cleft lip
and palate?
Phenytoin
What are the classic physical examination findings
in Pierre Robin sequence?
● Micrognathia
● Glossoptosis
● Cleft palate
What is van der Woude syndrome?
An autosomal dominant disorder characterized by lower-lip pits, cleft lip and palate, congenital heart disease, syndactyly, and ankyloglossia
What are some of the physical examination
findings in velocardiofacial syndrome?
Facial asymmetry with a long midface, inferior displacement
of the auricles, widened nasal base with bulbous nasal tip, micrognathia, microcephaly, medially displaced internal carotid arteries
What is the difference between a complete and incomplete cleft lip?
A complete cleft is a full-thickness defect of the entire height
of the lip with extension into the nose. An incomplete cleft does not involve the entire vertical height of the lip and contains a web of bridging tissue across the nasal aperture.
Describe the anatomy of a bilateral cleft lip.
The orbicularis oris fibers travel parallel to the edges of the
cleft. Medially, the muscle fibers insert into the columella,
and laterally the fibers insert into the nasal ala. The prolabial segment is composed of nonfunctional fibrous tissue. The premaxilla and central maxillary alveolus are protruberant.
What physical examination findings are associated
with a submucous cleft palate?
● Bifid uvula
● Notching of the hard palate
● Palpable or visible diastasis of the midline palatal
musculature
Which muscles contribute to the velopharyngeal
sphincter?
Levator veli palatini, tensor veli palatini, palatoglossus,
palatopharyngeus, superior pharyngeal constrictor, and
musculus uvulae
Which muscle is primarily responsible for providing
velopharyngeal closure during speech production?
Levator veli palatini
In reference to cleft lip repair, describe “the rule of
10s.”
Cleft lip repair can be performed when the child is at least
10 weeks old, has a hemoglobin greater than 10 g /dl, and
weighs at least 10 pounds.
What are some techniques used to repair a
unilateral cleft lip?
Millard rotation advancement flap, LeMesurier quadrilateral
flap, Randall-Tennison triangular flap repair, Skoog and Kernahan-Bauer upper and lower lip Z-plasty repairs
What are some of the techniques described for cleft palate repair?
Primary veloplasty, double-opposing Z-plasty (Furlow pala-
toplasty), bipedicled flap palatoplasty (von Langenbeck), palatal lengthening (V-Y pushback palatoplasty)
What are some of the complications of palatoplasty?
Bleeding, infection, oronasal fistula, velopharyngeal insufficiency, wound dehiscence, airway obstruction, and obstructive sleep apnea
Describe the nasal deformities associated with a
unilateral cleft lip.
There is an abnormally short medial crus, and an abnormally
long caudally displaced lateral crus on the cleft side. The nasal
floor is deficient, and the alar base is displaced posteriorly,
laterally, and inferiorly. The tip, columella, and septum are
deviated toward the non-cleft side.
