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Oral Surgery IV > Management of Cleft Lip and Palate patient > Flashcards

Management of Cleft Lip and Palate patient Flashcards

1
Q

what is the most common malformation in the oral maxillofacial region

A

cleft lip and palate

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2
Q

cleft lip and palate patients can have the following problems:

A
  • cosmetic issues
  • dental malalignment
  • speech problems
  • difficulty in swallowing
  • difficulty in hearing
  • altered facial growth
  • emotional disturbances
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3
Q

the scar tissue formed following surgical correction procedure on the palate can contribute to:

A

restricted growth of the maxilla

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4
Q

development of the upper lip is characterized by fusion of: and when does this occur

A

the maxillary processes with the lateral and medial nasal prominences
- 4-7 weeks of gestation

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5
Q

when does cleft lip develop

A

when there is failure of fusion of medial nasal process and maxillary processes

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6
Q

what is left cleft lip due to

A

failure of fusion of medial nasal process and maxillary process

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7
Q

what are the functions of the oricularis oris muscle

A
  • closes lips
  • compresses lips against teeth
  • protrudes lips
  • shapes the lips during speech
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8
Q

what muscle is in the prolabium in bilateral cleft

A

there is no muscle

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9
Q

where is the orbicularis oris muscle located and where does it insert

A
  • runs parallel to the edge of the cleft and inserts into the alar margin
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10
Q

what makes up the secondary palate

A
  • hard palate
  • soft palate
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11
Q

pre maxilla is formed from:

A

the medial nasal processes

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12
Q

describe the development of normal palate

A

palatal processes from maxillary processes fuse with premaxilla and nasal septum from anterior to posterior region

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13
Q

describe the development of the secondary palate

A
  • bony hard palate and the velum
  • process and fusion occurs between the 8th and 12th week of gestation
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14
Q

cleft palate occurs due to the failure of:

A

fusion of the lateral palatine processes, the nasal septum, and the pre maxilla (primary palate)

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15
Q

what are the normal muscle positions in the cleft palate

A

transverse orientation of levator veli palatini muscle in middle portion of the soft palate

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16
Q

what are the muscle positions in a patient with cleft palate

A

the levator veli palatini muscle is oriented more longitudinally and insert on posterior edge of palatal bone and along bony cleft margins

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17
Q

what is the normal velopharyngeal function

A

the velum needs to be closed and the oral and nasal cavities separated when we swallow and during the production of most speech sounds

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18
Q

what is the normal velopharyngeal mechanism controlled by

A

the velum (soft palate)

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19
Q

what muscles form the velopharyngeal sphincter

A
  • superior constrictor
  • levator veli palatini
  • tensor veli palatini
  • palatopharyngeus
  • palatoglossus
  • muscularis Uvulae
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20
Q

what is velopharyngeal incompetence

A

primary palatal repair surgery that is performed to close the palatal cleft defect results in scar tissue formation of the soft palate. this results in compromised function of the velopharyngeal mechanism

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21
Q

during VPI:

A

the velopharyngeal mechanism is incapable of separating the oral and nasal cavities during swallowing and speech

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22
Q

what are the etiologies of cleft lip and palate

A
  • multifactorial
  • unknown
  • genetic predisposition
  • genetic disorders
  • teratogenically induced disorders
  • mechnically induced abnormalities
  • other factors
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23
Q

what is the genetic predisposition of cleft lip and palate

A

family history of cleft lip and palate increases risk in 1st degree relatives 1:25 live births

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24
Q

what are the mechanical induced abnormalities that can cause cleft lip and palate

A
  • amniotic rupture
  • intrauterine crowding, uterine tumors, irregularly shaped uterus
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25
what are the other factors that can cause cleft lip and palate
- maternal epilepsy - drugs- steroid, diazepam, phenytoin - oligohydramnios - viral fever- rubella - poor nutrition - DM - exposure to radiation - increased maternal age
26
what is the incidence of cleft lip and palate in the US
1 in 750 births
27
submucous clefts are more ____ with an incidence of:
rare; 1/1200 births
28
the incidence of clefts is _____-
increasing
29
clefts more common in ______ and tend to be _____
males; more severe
30
what ethnicities have the highest incidence of clefts
native north americans then asians then caucasians and then africans
31
what are the distributions for cleft types
- cleft lip alone: 20% (18% unilateral, 2% bilateral) - cleft lip and palate: 50% (38% unilateral, 12% bilateral) - cleft palate alone - 30%
32
cleft deformity affects left side in ____ of cases
60%
33
anatomic classification of cleft lip and palate is based on
- location - completeness (incomplete/complete) - extent
34
clefts can be classified as:
- unilateral or bilateral cleft of the lip - unilateral cleft of the lip and palate - bilateral of the lip and palate - cleft palate alone - submucous cleft - bifid uvula
35
describe the unilateral cleft of the lip
- involves the vermillion border of the upper lip and may extend through the lip toward the nostril - affects the shape of the nose - unilateral clefts usually occur on the left side - cleft runs entire length of lip to floor of nose - abnormal muscle pulls distorts nose extensively and creates wide clefts between the lip segments
36
describe the complete unilateral cleft of the lip and palate
extends from the external portion of the upper lip, through the alveolar ridge and through the hard and soft palates
37
describe the bilateral cleft of the lip
- involves the vermillion border of the upper lip and may extend through the lip toward the nostril - affects the shape of the nose - bilateral clefts usually involve the palate
38
describe the bilateral cleft of the lip and palate
- the lip and the alveolar ridge is cleft under both nostrils and the central portion of the lip, alveolar ridge and the premaxilla area are positioned abnormally - the tip of the nose is attached directly to the lip - most severe form of cleft
39
describe the submucous cleft
- muscular cleft of the soft palate - cleft is covered by a thin layer of mucosal tissue that can sometimes hide it - the muscles of the soft palate fail to fuse
40
a bifid uvula sometimes accompanies:
a submucous cleft
41
what are the sequence of interventions for cleft lip and palate across specialies and when are these done
- consultations with mutispecialty: cleft deformity exam, advice on feeding, treatment plan. 3 days + or - - pediatrics: full exam, 3 days + or - - orthodontics: suction and drinking plate, pre-surgical naso-alveolar molding, 3 days + or - - genetics: parent counseling, 3 days + or - - psychology: parent counselling, 3 days + or - - speech and hearing sciences: hearing test, 3 months - oral and maxillofacial surgery or plastic surgery: primary closure of lip, 3-4 months - oral and maxillofacial surgery or plastic surgery: primary closure of palate, 11-12 months - speech and hearing sciences: indirect speech therapy by parens under guidance of speech therapist, 1-3 years - speech and hearing sciences, oral and maxillofacial surgery or plastic surgery or otolaryngologist: speech therapy + or - nasopharyngeal + or - pharyngoplasty, 3-6 years - oral and maxillofacial surgery or plastic surgery or otolaryngologist: speech therapy + or - nasopharyngeal + or - pharyngoplasty, , 6-9 years - orthodontist and oral and maxillofacial surgery: pre and post grafting orthodontic treatment and alveolar bone grafting, 9-11 years - orthodontics: comprehensive orthodontic treatment, 14 years - oral and maxillofacial surgery or plastic surgery: orthognathic surgery, lip revision, nose revision, 18 years
42
what is pre surgical naso alveolar molding for
complete cleft lip and palate- both unilateral and bilateral
43
when does NAM treatment begin
in the first week of life and lasts until the patient is going to undergo primary lip repair surgery
44
what is the main goal of NAM treatment
to reduce the severity of the cleft prior to primary lip surgery by closing the gaps between the lips/alveolar ridge and also improving the symmetry of the nose
45
how does NAM treatment help the surgeon and the patient
- helps the surgeon to perform the primary lip repair with more ease as there is less tension across the cleft margins following the NAM treatment - the patient has minimal post op scar and very favorable aesthetic result following the primary lip surgery
46
what is the rule of 10s in the surgical closure of cleft lip
- 10 weeks old - 10 pounds of body weight - 10 grams of hemoglobin
47
what are the anatomical considerations with cleft lip
- nasal floor communicates with the oral cavity - maxilla on the cleft side is hypoplastic - columella is displaced to the cleft side - nasal ala is displaced laterally, posteriorly and inferiorly displaced - lip muscles insert into the ala and columella
48
what is the most commonly used surgical technique for closure of unilateral cleft lip and palate
millard's rotation advancement flap
49
what are the techniques for cleft palate repair
- Von Langenbeck Technique - Wardill Technique
50
trend for cleft palate repair is:
less scarring and less tension on the palate
51
scarring on the palate may cause:
impaired midfacial growth (alveolar arch collapse, midface retrusion, malocclusion)
52
facial growth may be less affected if surgery is delayed until _______ but ______ may suffer
18-24 months; feeding, speech, socialization
53
in palatoplasty we achieve a three layered closure of:
- nasal layer - muscle - oral layer
54
repair of the palate is directed at:
producing normal speech, restoring eustachian tube function, attaining closure of oronasal fistulas and minimizing alterations in maxillary growth
55
during VPI, the velopharyngral mechanism is incapable of:
separating the oral and nasal cavities during swallowing and speech
56
what are the indications for a pharyngoplasty
- pharyngeal flap surgery may be recommended to resolve VPI after patients prove unable to achieve significant speech improvements through speech therapy - other requirements to qualify for the surgery include a short and immobile or easily fatigued palate
57
when is pharyngeal flap surgery done
6-9 years of age
58
what are the amount of cases that need pharyngoplasty
25%
59
what are the goals of pharyngoplasty for correction of VPI
eliminate the symptoms of hypernasality and eliminate audible nasal emissions without causing complete obstruction of the velopharygneal port, allowing for nasal breathing and nasal resonance
60
what is the most common method for secondary management of VPI
pharyngeal flap
61
describe the pharyngeal flap surgery
a mucosal flap from the posterior pharyngeal wall is attached to the soft palate, creating a midline subtotal obstruction of the oral and nasal cavities with 2 small lateral openings, or ports, that ideally remain patent during respiration and nasal consonant production
62
when is secondary alveolar bone grafting done
- before eruption of permanent canine - when the root of the canine is 1/3-2/3 formed - between ages 9-11 years old
63
in CLP dental age is usually ____ chronological age
behind
64
what do you need in secondary alveolar bone grafting
3 layered closure
65
what are the goals for secondary alveolar bone grafting
- provide bone for the eruption and/or orthodontic repositioning of teeth - closure of oro-nasal fistulas - support and elevation of the alar base - stabilization of the pre maxilla in bilateral cases - provide continuity of the alveolar ridge
66
what procedure is used in orthognathic surgery for CLP
Lefort 1 osteotomy to advance retruded maxilla
67

Oral Surgery IV (10 decks)

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