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Y4R4 - Surgery II 👨‍⚕️ > L3: Cleft Lip & Palate > Flashcards

L3: Cleft Lip & Palate Flashcards

1
Q

Embryology of Face

A
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2
Q

Embryology of Face

  • Fronto-Nasal Process
A

a. Forehead.
b. Nose.
c. Philtrem.
d. Premaxilla.

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3
Q

Embryology of Face

  • 2 Maxillary Processes
A
  • Cheeks.
  • Upper lip except philtrum.
  • Nasal septum.
  • 2 lateral palatine processes.
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4
Q

Embryology of Face

  • 2 Mandibular Processes
A

a. Cheek cover mandible.
b. Mandible.
c. Lower lip.

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5
Q

The lip is formed of 3 layers: ……

A

Skin, muscle & mucous membrane.

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6
Q

Vermillion

A

the red part of the lip between the skin & the mucous membrane.

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7
Q

White roll

A

White line demarcate the junction between the skin and the vermilion.

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8
Q
  • The upper lip is characterized by a median cosmetic unit (the philtram) that projects downward in the vermilion creating Cupid’s bow.
A

…

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9
Q
  • Orbicularis oris is the main muscle responsible of the function of the lip, Its fibers normally decussate in the midline.
A

…

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10
Q

Anatomically, the palate is divided into:

A
  1. Hard palate: The anterior bony part.
  2. Soft palate: The fleshy posterior part composed of 5 pairs of muscles.
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11
Q

The palate is divided embryologically into:

A
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12
Q

Incidence of Cleft lip & Palate

A

Cleft lip & palate: One in 700 live births 1:700

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13
Q

Incidence of Cleft lip Alone

A

Cleft lip alone (15-20% of all cleft patients):

  • Upper lip > Lower lip.
  • Unilateral cleft lip (80%) > Bilateral cleft lip (20%).
  • Left side > Right side.
  • Male > Female.
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14
Q

Incidence of Cleft Palate Alone

A

Cleft palate alone (40%)

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15
Q

Incidence of Cleft lip & Palate Combined

A

Cleft lip and palate (45% commonest presentation)

  • 85% of bilateral lip & 70% of unilateral lip are associated with cleft palate.
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16
Q

Etiology of Cleft Lip & Palate

A
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17
Q

Etiology of Cleft Lip & Palate

  • Genetic
A
  • A Child with cleft lip has 30% chance of having an associated syndrome. Yet, most cleft patients are non-syndromic.
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18
Q

Etiology of Cleft Lip & Palate

  • Environmental
A
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19
Q

Components of deformities in cleft patients

A
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20
Q

How to Describe a Cleft Lip?

A
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21
Q

How to Describe a Cleft Lip?

  • Upper Lip or Lower Lip?
A
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22
Q

How to Describe a Cleft Lip?

  • Median or Lateral?
A
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23
Q

How to Describe a Cleft Lip?

  • Unilateral or Bilateral?
A
24
Q

How to Describe a Cleft Lip?

  • If Unilateral, ……..
A
25
Q

Incomplete Clift Lip

A
26
Q

Complete Cleft Lip

A
27
Q

Alveolar Defects

A

Cleft lip may be associated with defect in the gum & premaxilla (cleft alveolus) or not.

28
Q

Nasal deformities

A
29
Q

Cleft Palate

A
30
Q

Types of Cleft Palate

A
31
Q

Types of Cleft Palate

  • Cleft of 2ry Palate only (Post. to incisive foramen)
A

a. Cleft uvuia.
b. Cleft soft palate.
c. Cleft soft & hard palate (Intermaxillary)

32
Q

Types of Cleft Palate

  • Cleft of 1ry & 2ry Palate
A
33
Q

Function of Speech is dependent on …….

A

5 paired muscles (levator veli palatini & tensor veli palatini are the most important).

34
Q

Insertion of these muscles

A
  • Normally these muscles form a transverse sling that enable the palate to move posteriorly to close oropharynx from nasopharynx.
35
Q

Abnormality in soft palate muscles in Cleft Palate

A
  • In cleft palate, the muscles are inserted aberrantly at edges of bony cleft with velopharyngeal dysfunction.
36
Q

Pierre Robin Sequence

A
37
Q

Management of Pierre Robin Sequence

A
  • Airway obstruction is managed by instructions to keep the child in prone position.
  • Severe cases may need glossopexy or tracheostomy.
38
Q

Complications of Cleft Lip & Palate

A
39
Q

Complications of Cleft Lip & Palate

  • Impaired Normal Suckling
A
  • Abnormal lip function
  • Inability to create negative intra-oral pressure because of oro-nasal communication.
40
Q

Complications of Cleft Lip & Palate

  • Food Regurgitation into nasal Cavity
A
  • Acute sinusitis, aspiration: pnuemonia.
41
Q

Complications of Cleft Lip & Palate

  • Abnormal levator palati insertion prevent adequate areation of Eustachian tube leading to
A
  • Inadequate emptying of middle ear
  • Predispose to recurrent otitis media.
  • This may lead to hearing loss.
42
Q

Complications of Cleft Lip & Palate

  • Interference with normal teeth alignment in cases with
A
  • Alveolar defects & cleft of primary palate (Premaxilla)
43
Q

Complications of Cleft Lip & Palate

  • Speech Defects
A

Speech defects secondary.to:
- Inadequate velopharyngeal menanism causing nasal tone.
- Hearing loss resulting from recurrent otitis media.

44
Q

Complications of Cleft Lip & Palate

  • Distortion of facial growth
A
  • Affection of bony centers of the maxilla on early surgical repair of hard palate.
45
Q

Complications of Cleft Lip & Palate

  • Disfigurements & Psychological upset of parents.
A

….

46
Q

Multidisciplinary care of cleft patients

A
47
Q

Management of Cleft Lip & Palate

A
48
Q

Management of Cleft Lip & Palate

  • Care At Birth
A
49
Q

Management of Cleft Lip & Palate

  • At age 3-6 months
A
50
Q

Management of Cleft Lip & Palate

  • At age about 2 weeks
A
51
Q

Management of Cleft Lip & Palate

  • At age 4-6 Months
A

Role of Otolaryngolgists:
* Assess & manage recurrent otitis media to avoid hearing affection.

52
Q

Management of Cleft Lip & Palate

  • At age 9-18 months
A
53
Q

Management of Cleft Lip & Palate

  • At age 2.5 - 5 years
A

Speech pathologist
- assess speech & velopharyngeal function.

Pediatric/ Plastic surgeon
- correct velopharyngeal dysfunction surgically if required (Pharyngoplasty)

54
Q

Management of Cleft Lip & Palate

  • At age 4 - 7 Years
A

Dentists/ Oral surgeons

  • Correct teeth abnormalities.
55
Q

Management of Cleft Lip & Palate

  • At age 7 - 10 Years
A

Platic surgeons
- correct alveolar defect by bone graft.

56
Q

Management of Cleft Lip & Palate

  • At age > 12 years
A

Plastic surgeons/ Otolaryngolists

  • Correct residual nasal deformities (Rhinoplasty).

Y4R4 - Surgery II 👨‍⚕️ (33 decks)

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