L3: Cleft Lip & Palate Flashcards
1
Q
Embryology of Face
A
2
Q
Embryology of Face
- Fronto-Nasal Process
A
a. Forehead.
b. Nose.
c. Philtrem.
d. Premaxilla.
3
Q
Embryology of Face
- 2 Maxillary Processes
A
- Cheeks.
- Upper lip except philtrum.
- Nasal septum.
- 2 lateral palatine processes.
4
Q
Embryology of Face
- 2 Mandibular Processes
A
a. Cheek cover mandible.
b. Mandible.
c. Lower lip.
5
Q
The lip is formed of 3 layers: ……
A
Skin, muscle & mucous membrane.
6
Q
Vermillion
A
the red part of the lip between the skin & the mucous membrane.
7
Q
White roll
A
White line demarcate the junction between the skin and the vermilion.
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
…
9
Q
- Orbicularis oris is the main muscle responsible of the function of the lip, Its fibers normally decussate in the midline.
A
…
10
Q
Anatomically, the palate is divided into:
A
- Hard palate: The anterior bony part.
- Soft palate: The fleshy posterior part composed of 5 pairs of muscles.
11
Q
The palate is divided embryologically into:
A
12
Q
Incidence of Cleft lip & Palate
A
Cleft lip & palate: One in 700 live births 1:700
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.
14
Q
Incidence of Cleft Palate Alone
A
Cleft palate alone (40%)
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.
16
Q
Etiology of Cleft Lip & Palate
A
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.
18
Q
Etiology of Cleft Lip & Palate
- Environmental
A
19
Q
Components of deformities in cleft patients
A
20
Q
How to Describe a Cleft Lip?
A
21
Q
How to Describe a Cleft Lip?
- Upper Lip or Lower Lip?
A
22
Q
How to Describe a Cleft Lip?
- Median or Lateral?
A
23
Q
How to Describe a Cleft Lip?
- Unilateral or Bilateral?
A
24
Q
How to Describe a Cleft Lip?
- If Unilateral, ……..
A
25
Incomplete Clift Lip
26
Complete Cleft Lip
27
Alveolar Defects
Cleft lip may be associated with defect in the gum & premaxilla (cleft alveolus) or not.
28
Nasal deformities
29
Cleft Palate
30
Types of **Cleft Palate**
31
Types of **Cleft Palate**
- Cleft of 2ry Palate only (Post. to incisive foramen)
a. Cleft uvuia.
b. Cleft soft palate.
c. Cleft soft & hard palate (Intermaxillary)
32
Types of **Cleft Palate**
- Cleft of 1ry & 2ry Palate
33
Function of Speech is dependent on .......
5 paired muscles (levator veli palatini & tensor veli palatini are the most important).
34
Insertion of these muscles
- Normally these muscles form a transverse sling that enable the palate to move posteriorly to close oropharynx from nasopharynx.
35
Abnormality in soft palate muscles in Cleft Palate
- In cleft palate, the muscles are inserted aberrantly at edges of bony cleft with velopharyngeal dysfunction.
36
**Pierre Robin Sequence**
37
Management of **Pierre Robin Sequence**
- Airway obstruction is managed by instructions to keep the child in prone position.
- Severe cases may need glossopexy or tracheostomy.
38
Complications of **Cleft Lip & Palate**
39
Complications of **Cleft Lip & Palate**
- Impaired Normal Suckling
- Abnormal lip function
- Inability to create negative intra-oral pressure because of oro-nasal communication.
40
Complications of **Cleft Lip & Palate**
- Food Regurgitation into nasal Cavity
- Acute sinusitis, aspiration: pnuemonia.
41
Complications of **Cleft Lip & Palate**
- Abnormal levator palati insertion prevent adequate areation of Eustachian tube leading to
* Inadequate emptying of middle ear
* Predispose to recurrent otitis media.
* This may lead to hearing loss.
42
Complications of **Cleft Lip & Palate**
- Interference with normal teeth alignment in cases with
- Alveolar defects & cleft of primary palate (Premaxilla)
43
Complications of **Cleft Lip & Palate**
- Speech Defects
Speech defects secondary.to:
- Inadequate velopharyngeal menanism causing nasal tone.
- Hearing loss resulting from recurrent otitis media.
44
Complications of **Cleft Lip & Palate**
- Distortion of facial growth
- Affection of bony centers of the maxilla on early surgical repair of hard palate.
45
Complications of **Cleft Lip & Palate**
- Disfigurements & Psychological upset of parents.
....
46
Multidisciplinary care of cleft patients
47
Management of Cleft Lip & Palate
48
Management of Cleft Lip & Palate
- Care At Birth
49
Management of Cleft Lip & Palate
- At age 3-6 months
50
Management of Cleft Lip & Palate
- At age about 2 weeks
51
Management of Cleft Lip & Palate
- At age 4-6 Months
**Role of Otolaryngolgists:**
* Assess & manage recurrent otitis media to avoid hearing affection.
52
Management of Cleft Lip & Palate
- At age 9-18 months
53
Management of Cleft Lip & Palate
- At age 2.5 - 5 years
**Speech pathologist**
- assess speech & velopharyngeal function.
**Pediatric/ Plastic surgeon**
- correct velopharyngeal dysfunction surgically if required (Pharyngoplasty)
54
Management of Cleft Lip & Palate
- At age 4 - 7 Years
**Dentists/ Oral surgeons**
- Correct teeth abnormalities.
55
Management of Cleft Lip & Palate
- At age 7 - 10 Years
**Platic surgeons**
- correct alveolar defect by bone graft.
56
Management of Cleft Lip & Palate
- At age > 12 years
**Plastic surgeons/ Otolaryngolists**
- Correct residual nasal deformities (Rhinoplasty).
