Lip and Palat Flashcards
The critical period for cleft lip and palate embryologic development is 4 to 7 weeks
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The critique of the Veau classification system is that it lacks terminology to describe isolated clefts of palate?
The critique of the Veau classification system is that it lacks terminology to describe isolated clefts of the lip.
Complete orbicularis oris muscle disruption is the hallmark of a true cleft lip
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Cleft lip results from failure of fusion
of the medial nasal process and the maxillary prominence
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The medial nasal prominence serves as the precursor to the nasal
tip, columella, philtrum, and premaxilla and the nasal ala
F The medial nasal prominence serves as the precursor to the nasal
tip, columella, philtrum, and premaxilla. The lateral nasal prominence is
the precursor to the nasal ala
Thelower lipand jaw derive from the bilateral mandibular prominences,
which fuse across the midline
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Palatogenesis initiates during the sixth week of development
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the medial nasal prominences fuse to form the intermaxillary segment
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In the eight week of development, the palatine shelves assume a horizontal orientation,
F In the seventh week of development, the palatine shelves assume a horizontal orientation, right before left
fusion of the hard palate complete by the 10th week and soft palate
fusion achieved by the 12th week
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Male has more risk to develope isolated cleft palate
F I :2 male-to-female gender
predominance for isolated cleft palate
2:1 male-to-female gender predominance for CLIP
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Isolated CLIP remains more common than isolated
cleft palate which is more common than isolated cleft lip with a
5:3:2 ratio
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For patients with syndromic
etiologies for CLIP, such as van der Woude syndrome, the risk
to subsequent children will be 10%
F 50%
Veau classification
Class I: cleft of the soft palate
Class II: cleft ofthe hard and soft palate up to the incisive foramen
Class III: clefts of the soft and hard palate extending unilaterally
through the alveolus
Class IV: clefts of the soft and hard palate extending bilaterally
through the alveolus
The critique of the Veau classification system is that it lacks terminology to describe isolated clefts of the lip
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Kernahan and Stark suggested that characterization should be based on the
embryologic origins of the primary and secondary palate
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Kernahan
and Stark classified clefts
- Clefts of structures anterior to the incisive foramen
- Clefts of structures posterior to the incisive foramen
- Clefts affecting structures anterior and posterior to the incisive
foramen
The striped-Y simplified record keeping and allowed classification of
clefts to become a visual rather than cognitive exercise
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lowercase
letters (I, a, h, s) for incomplete clefts of a region
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The nasal
deformity associated with microform cleft lip
s variable but typically demonstrates some degree of lower lateral alar slumping, the horizontal orientation of the nostril, depression of the nostril sill, and cephalo-retrodisplacement of the alar base.
straight-line surgery can be used in microform cleft lip
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Separation that is greater than 3 mm in height
compared with the Cupid’s bow on the uninvolved side defines a true
incomplete cleft lip from a microform cleft
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Complete orbicularis oris
muscle disruption is the hallmark of a true cleft lip
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if the
cleft extends to less than two-thirds the height of the lip, there may be
intact orbicularis oris muscle fibers traversing the superior aspect of
an incomplete cleft
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A complete cleft with a Sirnonart band can be
differentiated from an incomplete cleft by the presence of an underlying complete alveolar cleft
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In incomplete unilateral cleft vertical lip height is diminished on the noncleft side with an increasing paucity of vermillion as it tracks into the cleft margin.
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The cleft nasal deformity associated with unilateral cleft lip
lower lateral cartilage hypoplasia,
flattening of the cleft side alar dome,
lack of upper lateral and lower lateral cartilage overlap,
subluxation of the lower lateral cartilage,
a horizontal orientation of the nostril,
and alar base displacement posteriorly and superiorly due to the underlying maxillary hypoplasia
caudal septum
and anterior nasal spine are typically deviated toward the noncleft side
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incomplete forms and microform clefts can be seen with asymmetry in cleft severity from side to side in bilateral cleft lip
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Causes of fattening of the alar domes in bilateral cleft lip
secondary to subluxation of the
lower lateral cartilages from their normal anatomic position overlying
the upper lateral cartilages
Underdevelopment or absence of the
anterior nasal spine causes posterolateral displacement of the medial
crural footplates and contributes to a lack ofnasal projection a broad
nasal tip, and significant foreshortening of the columella
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Tympanostomy and placement of pressure equalization tubes are typically performed at the
time of primary palatoplasty.
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50% of all isolated clefts occur
in the setting of an associated syndrome or anomaly.
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wide U-shaped cleft palate occures n the case of Pierre Robin
sequence
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Submucous Cleft Palate is defined by a classic triad offindings including a bifid uvula, notching of the posterior hard palate, and midline
mucosa! attenuation known as the zona pellucida
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Anatomically,
there is anterior displacement ofthe levator veli palatini muscles onto
the notched hard palate leading to variable degrees of velopharyngeal dysfunction (VPD) despite the lack of an overt cleft
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patients may still benefit from palatoplasty beyond the age of critical
language development
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Passive methods include
lip taping, nasoalveolar molding, and lip adhesion
Active methods such as the Latham device exert a progressive and tunable force across tissues to create the desired effect
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Lip taping applies as early as the first week of life
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significantly reduce alveolar gaps with taping
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Lip
adhesions have been demonstrated to significantly reduce alveolar
gaps and normalize preoperative cleft severity but at the cost of an
additional operation prior to definitive repair
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Nonalveolar molding (NAM) benefits
aligning the alveolar segments and helping to correct the preoperative cleft
nasal deformity by supporting the alar domes, lengthening the columella and improving nasal tip projection and symmetry
Latham pin-retained device that is surgically implanted into the alveolar segments
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In bilateral cases the device was used to rein in the premaxilla while
simultaneously expanding the palatal arch
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secondary growth disturbance can occurs with NAM
F with LATHAM
Rose and Thompson via curvilinear incisions, now known as the Rose-Thompson effect
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