Lecture 1 Flashcards
1
Q
Phases of intra-uterine development:
A
Blastogenesis
Embryogenesis
Fetogenesis
2
Q
Blastogenesis is days ____
A
0-15
3
Q
Embryogenesis is days ____
A
16-75
4
Q
Fetogenesis is days ____
A
76 to birth
5
Q
A zygote is the joined _______ it is seen during which phase of uterine development: ________
A
ovum and sperm
Blastogenesis
6
Q
A Morula is on day ___ it is the rapid duplication of cells _____ cells
A
day 3
12-32
7
Q
A ______ embeds in uterine wall around day 5 or 6.
A
Blastocyst
8
Q
The blastocyst is made up of ________ cells (which become the baby) and ______ cells (form placenta)
A
embryoblast
trophoblast
9
Q
List three important things in blastogenesis:
A
zygote
Morula
blastocyst
10
Q
Embryogensis is when the ______ and the three germ layers form.
A
Gastrula
11
Q
The gastrula forms on day ____
A
14-20
12
Q
The three germ layers are:
_________ , _________, _________
A
ectoderm, endoderm and mesoderm
13
Q
Which germ layer develops into the nervous system?
A
ectoderm
14
Q
On day 16 the ______ forms
A
neural plate
15
Q
Around day ____ the neural tube is formed. The _____ end of the tube develops into the brain.
A
day 21
front (rostral)
16
Q
Around day 28 the embryo begins to fold into a ______ and the head and tail fold develop.
A
C- shape
17
Q
The development of the brachial apparatus starts at the beginning of week ____ just before the ____
A
4
folding process
18
Q
In fish the brachial arches are gills. Human embryo’s have ______ brachial arches that develop into structures of the _____ and ____
A
pharyngeal
face and neck
19
Q
There are ___ pharyngeal arches.
A
6
20
Q
List what each pharyngeal arch forms:
A
1 - mandible/ maxilla, muscles of mastication (trigemina -mandibularl)
2 - Stapes, Upper part of hyoid, facial muscles (facial)
3 - greater cornu and lower hyoid, stylopharyngeus (glossopharyngeal)
4 - Thyroid cartilage, pharyngeal muscles (vagus)
5 - disappears
6 - Cricoid and arytenoids, laryngeal nerves (vagus rln)
21
Q
In week 3 three vesicles (blisters) form:
A
1) prosencephalon
2) mesencephalon
3) rhomencephalon
22
Q
T or F: Development of the forehead and the central midface is controlled by the prosencephalon
A
True
23
Q
T or F: Development of the lateral and lower face is controlled by the mesencephalon
A
False - rhombencephalon
24
Q
If the vesicle blisters don’t communicate the timing gets messed up and _______ will form
A
clefts
25
The prosencephalon or _________
forebrain
26
The mesencephalon or _________
midbrain
27
The rhomencephalon or ________
hindbrain
28
The prosencephalon develops into the _______ and __________
telencephalon
| diencephalon
29
During the secondary division the mesencephalon remains the _____
mesencephalon
30
The rhomencephalon develops into the _________ and ____________
metencephalon
| myelencephalon
31
The telencephalon develops from the _______ and into :
prosencephalon
| cortex, caudate, putamen, globus pallidus
32
The diencephalon develops from the ________ and into:
prosencephalon
| thalamus, hypothalamus, subthalamus, epithalamus, subthalmic nucleua
33
The Mesencephalon develops into the:
midbrain, substantia nigra
34
The metencephalon develops from the ______ and into:
Rhomencephalon
| Pons and cerebellum
35
The mylencephalon develops from the _______ and into the:
rhomencephalon
| medulla
36
During embryonic gestation the _______ from the surface tissue or outlines for organs and the _______ (multipurpose stem cells) differentiate into the structures.
epithelial cells
| mesenchymal cells
37
Limb bud appear between day ___
day 37 and 41
38
The opening between the maxilla and mandible is called:
stomoderm
39
T or F: Heart development is on day 41
True
40
T or F: All structures of the baby are in place at week 10 the baby just needs to grow and develop
False -Week 18
41
The most important week for development of the face is _____
week 8
42
T or F: By the end of week 9 there is still a bifid uvula that takes a few weeks to close
True
43
**Describe the 4 important weeks in craniofacial deveopment:
1) Week 6 - formation of lips complete
2) Week 9 - formation of hard palate complete
3) Week 10 - formation of soft palate complete
4) Week 12 - formation of the uvula complete
44
We get clefts along ______
fissure lines
45
A vertical cleft forms between the _________ and _______
median nasal and lateral nasal processes
46
A horizontal cleft forms between the ________ and ___________
maxillary and mandibular sections
47
An oblique cleft forms between the ________ and _________
maxillary and lateral nasal processes
48
The primary palate consists of the _______ and _______.
premaxilla and alveolar ridge
49
The secondary palate consists of the _______ and _______.
hard and soft palate
50
Palatal fusion is a 2 step process: Describe the steps:
Step 1: Formation of the primary palate (fusion of the premaxilla and the alveolar ridge)
Step 2: Formation of the secondary palate (median fusion of the lateral palatal shelves)
51
T or F: isolated cleft lip and/ or alveolus and isolated cleft palate are caused by different pathomechanism
True - due to the two fold palatal fusion process
52
Define aplasia:
something isn't there
53
Define hypoplasia:
something there but not enough
54
Define normoplasia:
typical
55
Define hyperplasia:
too much of it is there
56
In ______ the epithelium bridge has not been established. In ________ the epithelium bridge has been established but not replaced with mesenchymal stem cells
Primary cleft
| Secondary cleft
57
Two theories why a cleft lip and palate occur?
1) The multifactorial threshold model
| 2) The major gene model
58
Clefting concordance in twins for cleft tells us what?
Since monozygotic concordance is 25-40% both environment and genetics play a role.
59
List possible teratogens that contribute to cleft lip and palate:
1) Rubella
2) thalidomide
3) narcotic substances and alcohol
4) anti-convulsants
5) acne medication
6) cigarettes
7) lack of vitamin B
60
T or F: A higher maternal age is more crucial to thepathogenesis of cleft palate
False- higher paternal age. Although both contribute
61
____ % of all clefts are uni- or bilateral total (from lip to soft palate)
50%
62
T or F: Left sided clefts are twice as frequent as right-sided clefts
True
63
The overall ratio of cleft is ________ but for isolated cleft palate it is _______
2 males: 1 females
| 2 females: 1 male
64
Prevalence of cleft lip and palate in canada:
1: 500-750
65
The prevalence of isolated cleft palate are _____ around the world.
Similar
66
List possible explanations for the increasing incidence of cleft palate over the years:
- decreased neonatal mortality
- environmental factors
- increased marriages and children for people with cleft
67
All parents have an ____% chance of having a child with cleft.
0.17
68
Parents who already have a child with cleft have a ____% chance of having a child with cleft if the child is only person with cleft of a ____% chance if other family members.
2-5%
| 10-12%
69
A person with cleft have a ____% chance of having a child with cleft if the child is only person with cleft of a ____% chance if other family members.
2-5%
| 10-12%
70
An uneffected sibling of a child with cleft have a ____% chance of having a child with cleft if the child is only person with cleft of a ____% chance if other family members.
1%
| 5-6% chance
71
Signs of a submucous cleft soft palate:
1) Bifid uvula
2) Velar midline furrow (blueish midline in soft palate)
3) Hard palate notch (felt at posterior of hard palate)
4) Insertion of the levator muscles into the hard palate
72
What are the signs of an occult submucous cleft soft palate?
The cardinal signs of ‘overt’ submucous cleft soft
palate are absent in the occult form.
• The velar muscles insert into the hard palate
• best detected endoscopically as a midline groove
during velar elevation (in lieu of a velar
eminence). See two peaks instead of one
73
T or F: Bifid uvula by itself is not usually a
pathological sign unless the patient exhibits
symptoms of velopharyngeal dysfunction
such as hypernasality or nasal regurgitation.
True
74
T or F: The patient with an ‘overt’ or occult
submucous cleft palate will
exhibit symptoms such as hypernasality or
nasal regurgitation
False
| - may or may not exhibit symptoms but the cleft is only an issue if resonance or feeding are affected
75
A cleft palate can affect:
- breathing
- swallowing and facial muscle function
- speech
- hearing
- facial esthetics
- dental esthetics
- self concept and psychosocial development
76
Care for a cleft palate patient should always be provided by a specialized team in a CLEFT CENTRE.
The 7 team members are:
```
Plastic Surgery (Oral and Maxillofacial Surgery)
Pediatrics
Dentistry and Orthodontics
ENT
Audiology
Psychology/ Social Work
Speech Therapy
```
77
Five reasons why a cleft TEAM?
1) not possible for one specialty to
deal with all patient concerns
2) Ensures continuity, care is needed over a long period of time.
team ensures continuity
3) different aspects of the surgical and therapeutic
management have to be coordinated
4) families would have difficulties coordinating
professionals and appointments by themselves
5) a higher patient volume so more resources and expertise
78
Define multidisciplinary team:
care is provided independently by different disciplines and interaction is limited
79
Define interdisciplinary team:
professionals from various disciplines work together to coordinate the patient care
80
Define transdisciplinary team:
professionals from different disciplines truly understand each others’ tasks
81
Describe a treatment plan for a patient with unilateral cleft lip and palate:
Age 0;6: Lip closure surgery
Age 1: Closure of palate
Age 3: Onset of speech therapy (if necessary)
Age 6: Pharyngeal flap surgery (if hypernasal)
Orthodontic treatment when appropriate
Age 10: Secondary alveolar bone graft surgery
Age 18: Orthognathic sugery (if necessary)
82
Describe feeding plates:
- Inserted in the first days of life.
- They cover the palate and alveolar ridge.
- Prevent the tongue from going into the nasal cavity.
- Believed to be helpful for swallowing efficacy and oro-motor development.
- double as early orthodontic instruments to help guide the growth of the maxillary arch
83
T or F: Little hard proof for the treatment efficacy of feeding plates in terms of swallowing, tongue function and speech.
True
84
Describe Nasoalveolar molding:
- Intraoral molding plate guides the growth of
the alveolar ridges
- Adhesive tape is used to bridge the cleft lip
and help pull back a runaway premaxilla
- on a group level not necessarily effective but can be effective on an individual basis
85
___________: goal is to provide functionally adequate and aesthetically pleasing surgical reconstruction
____________: additional secondary corrections if the primary goal could not be attained
Primary operation (repair structure)
Secondary Operation (repair botched attempt)
86
List the three primary operations:
1) Lip repair
2) Alveolar bone graft
3) Palatal closure
87
Describe the primary operation: Lip Repair
- Close the cleft lip
- Reconstruct the muscle sling of the M.orbicularis oris
- Reconstruct the philtrum and Cupido’s bow
- Form the anterior floor of the nose
- Restore symmetry of the nose
88
Describe the primary operation: Alveolar bone graft
- A bone transplant is inserted into the alveolar cleft to close the bone defect. The lateral incisor or the canine of the adult dentition will then grow into the bone, and the patient will have a complete maxillary arch.
Timing:
• If the operation is done too early, the bone graft
may dissolve because it is not used by a tooth.
• If the operation is done too late, the tooth may
dissolve because it has no bone to grow into.
89
Describe the primary operation: Palatal closure
* The goal is to restore the roof of the mouth as well as the floor of the nose
* The closure is achieved by soft tissue transposition.
* While the bone defect remains open, the soft tissue closure provides adequate palatal function
