Midterm Flashcards
(203 cards)
1
Q
Describe the composition of the nasal septum
(MVP)
A
The bones of the septum include the maxillary crest, the vomer, and the perpendicular plate of the ethmoid.
2
Q
Define the major sutures of the skull
A
- Sagitall - crosses the skull vertically and divides the two partietal bones
- Coronal - across the top of the skull horizontally (like a crown) and separates the frontal bones and parietal bones.
- Lamboid - between the parietal, temporal and occipital bones.
- Metopic - divies the frontal bones at the midline and is bordered posteriorly by the coronal stuture.
3
Q
Features of the Face
Columella
A
The columella is like a supporting column in that it provides support for the nasal tip.
4
Q
Features of the face
Vermilion
A
Skin of the lip
5
Q
Features of the face
Philtrum
A
a long dimple or indentation that courses from the columella down to the upper lip
6
Q
Features of the face
Bridge of nose
A
is the saddle-shaped area that includes the nasal root and the lateral aspects of the nose.
7
Q
Features of the face
Ala
A
ala nasi is the outside curved side of the nostril
8
Q
Features of the face
Cupids bow
A
the top of the upper lip
9
Q
Features of the face
Philtral columns
A
These ridges are embryological suture lines that are formed as the segments of the upper lip fuse. The philtrum and philtral ridges course downward from the nose and terminate at the edge of the upper lip.
10
Q
Facial Skelton Features/Bones
Mandible
A
The bone that forms the lower jaw
11
Q
The bones of the septum include the _______, _________, __________-.
A
- Maxillary crest
- Vomer
- Perpendicular plate of the ethmoid
12
Q
Facial skeleton
Maxilla
A
The bone that forms the upper jaw.
13
Q
Facial skeleton
What are the palatine (hard palate) bones?
A
- the premaxilla (a single midline bone)
- the palatine processes of the maxilla
- the horizontal plates of the palatine bone.
- These bones are separated by embryological suture lines.
14
Q
Facial Skelton
Zygomatic bone
A
forms the cheeks and the lateral walls of the orbits
15
Q
Facial skeleton
Posterior nasal spine
A
A midline bony protrusion from the posterior border of the hard palate
16
Q
Facial skeleton
Anterior nasal spine
A
The anterior point of the maxilla that corresponds to the base of the columella.
17
Q
Cranial Skeleton
A
Frontal bone, parietal bone, occipital bone, temporal bones, sphenoid, ehtmoid.
18
Q
Facial landmarks on a 6-week embyro
A
- eyes are at 160 degrees at 6 weeks
- nasal pit
- medial nasal prominence
- stomodeum
- maxillary prominence
- mandibular arch ear hillocks
- 1st pharyngeal goove
19
Q
Describe the formation of the primary palate
A
- Begins “formation” at about 6 weeks
- finishes during the 7-8th week
- Embryological development of the face and palate is dependent on the formation of neural crest cells in the embryo
- Palate forms on its own, apart from the secondary palate
- Prior to palatal fusion, the tongue is in a superior and posterior position in the nasopharynx
- once the hard palate is formed, the velum is fused in midline, forming the median raphe. Lastly the uvula is formed. Fusion of the hard palate and velum is usually complete by 12 weeks.
20
Q
Describe the formation of the secondary palate
A
- Begins formation at 8 weeks and ends around 10 weeks
- 2 week window for the processes to occur and the maxillary shelves to spring up and the tongue to get out of the way so that the palate can fuse
21
Q
What is the difference between one-stage and two-stage closure of the palate
A
- One stage repair: 10 - 24 months
- the most common
- hard and soft palate are repaired all at one time
- Two stage repair: 12 - 24 months
- soft palate is closed then a month or so later the hard palate is closed
- surgeons like to close the palate before on year
- Repairs are done for help with speech outcomes
- there is a downside ,the early surgeries tend to retard the maxillary growth
22
Q
What is the purpose of a LeFort I
A
- includes the maxilla only. The maxilla is cut transversely, just above the tooth roots on the alveolar ridge all the way around and the base of the nose. This allows the surgeon to move the alveolar arch and palate as a single unit.
- Usually neutral or beneficial to speech
- will mobilize the alveolar arch and palatete
- teenage timing
23
Q
What is the purpose of a LeFort II?
A
- Maxilla is advanced plus the bridge of the nose (nasal pyramid)
- LeFort I plus the bridge of the nose
24
Q
What is the purpose of a LeFort III?
A
- Includes the maxilla, the nasal pyramid, part of the orbits and cheek bones are advanced.
25
What is the relationship between language development and CLP?
* Some reported that children with nonsyndromic clefts show some early deficits in prelinguistic skills during the first 3 years of life
* The open palate can also affect the infan't place of articulation.
* Unaffected infants use anterior sounds in prespeech production. In contrast, infants with clefts, regardless of type, babble with a predominant use of posterior consosnants, particularly glottal stops and velar.
* Severe hypernasality
* Language impairement usually mild secondary to signficant speech problems
*VP - Hoarseness
- High pitched voice
26
Delineate the system used to describe the size of the palatine tonsils
* 1+ tonsils are contained within faucial pillars
* 2+ tonsils extend minimally beyond the faucial pillars
* 3+ tonsils obstruct the oropharyngeal inlet to a moderate degree
* 4+ tonsils touch in the midline
27
What is Waldeyer's ring?
* Lingual tonsils + palatine + pharyngeal tonsils = waldeyer's ring (encircles the oral cavity)
* Usually by late teen/early adult years they shrivel up and go away
28
Describe problems an infant with CL/P might have with nursing
* difficulty with lip seal - if you have a cleft lip it is difficult to latch because the lip spreads
* difficulty with nipple compression
* difficulty developing negative pressure (sucking)
* Nasal regurgitation - the baby is putting in the effort to get the milk but it comes back up because of the opening
* difficulties depending on the type of cleft
29
Types of lip repair
(STM)
* Straight line repair/lip adhesion (rose-thompson) - tend to leave the lip a little tight
- basic
- done fairly often
* Triangular flap (randall-tennison)
- they add an "arrow" of tissue that gives the lip more fullness so it is not stretched as tight during growth
* Millard rotation advancement
- the triangular piece is put near the nostril as ell to help with nose structure
* Lip adhesion may precede definitive repair
* child might have a lip adhesion followed by a millard rotation repair a few weeks apart
30
# Rules of 10's
When is the lip repaired?
* 10 weeks
* 10 lbs
* 10 grams of hemoglobin in the blood
31
# Surgical Repair of the clieft palate
Von Langenbeck
* Incisions are made to help relax the tissue to be able to pull the tissue together without tear
32
# Surgical Repair of the clieft palate
V-Y Push Back (Wardill-Kilner)
In this procedure, the initial incisions are similiar to those of the von langenbeck procedure except instead of leaving the mucoperisoteum attached in the front of the mouth, it is cut across a V. The resulting open area is Y shaped. This frees up the mucoperisteum of the whole palate and allows it to be pushed back in an attempt to lengthen it.
33
# Surgical Repair of the cleft palate
Furlow Z-plasty
| Close velum and hard palate or just soft palate
* A plastic surgery technique that is used to lengthen tissue
* most complicated of the procedures
* The furlow z-palatoplasty involves reconstruction of the levator sling and lenthening the velum by closing it with opposing Z-plasties.
- This is done by borrowing tissue from the width of the velum to add to the length. The resulting scar looks like a Z.
- flaps from the oral side and nasal side of the velum are laid over each other
34
# Surgical Repair of the clieft palate
Intravelar veloplasty
A surgical reconstruction of the levator veli palatini sling during palatoplasty for correction of a cleft of the velum
35
Surgical repair techniques for cleft palate (V V F I)
* Von langenbeck
* V-Y push back (wardill-kilner)
* Furlow Z-plasty
* Intravelar veloplasty (veli/velum)
36
What are the long term/short term concerns with ankyloglossia
* Speech
* dental
- because if the tongue tip is restricted and doesn't have the normal amount of freedom kids can't sweep their teeth with their tongue
- their teeth don't stay as clean
* Breast feeding/bolus manipulation
* social
37
Discuss factors that increase risk for hypernasality with adenoidectomy
* Velum elevates up against adenoids
* Without adenoids the soft palate has to adjust to the new area gap and sounds often leaks through giving off a hyper nasal sound
* The soft palate will adjust and then speech will be ok
38
Descibe the three types of malocclusion: Class I, II, III
* Malocclusion refers to an abnormal dental relationship between the maxillary and mandibular teeth during biting
* Normal occlusion: mandibular first molar is 1/2 tooth ahead of maxillary first and molar
- most people fall into this category but with other anomalies
* Class I: normal occlusion with other dental anomalies
* Class II: Mandibular molar is even with or behind maxillary molar
* Class III: mandibular molar more than 1/2 tooth ahead of maxillar molar
- underbite
39
What is the effect of dentition on speech articulation?
* Obligatory errors: distortion errors caused by structural abnormaility
* Compensatory errors: distortion or substitution errors due to a modification in placement of tongue or lip position to compensate for the structural abnormality
* Class II and III malocclusion: distortion or substitution of lingual-alveolars and or bilabials, labio dental stops for bilabial stops, bilabial fricatives for labio-dental fricatives, and lingual alveolar distortions
* Missing teeth, rotated teeth, open bite: sibilant distortion, more so when anterior teeth are involved, /sh/, less often affricates may be distorted.
* Anterior crossbite: distortion of sibilants or lingual-alveolars. Dorsum contact for tongue tip
* Open bite: anterior distortion of sbililants and affricates
* Supernumerary or ectopic teeth: distortion of lingual-alveolars or interdentals
40
How does CL/P affect hearing acuity?
* Middle ear disease
- there is a high incidence of middle ear disease in CLP
- Incidence of MED is lower in children with cleft of primary palate only
- MED is the basis for most hearing loss in cleft lip and palate children
- Conductive hearing loss is expected, sensorineural hearing loss may be an indicator of a syndrome
41
What type of hearing loss is the most common for CL/P ?
* Incidence of conductive loss is higher
- younger = higher risk
- improves with age
- a lot of these incidences occur with illness and when they get older they become more immune to these illnesses
* Conductive loss improves with age
* Similiar incidence of hearing loss with submucous cleft
* No relationship between hearing loss and....
- type of palatal cleft
- type of VP management
- type of surgery
- age at time of surgery
42
What are the indications for adenoidectomy?
* recurrent sinusitis
* intractable middle ear effusion
* obstructive sleep apnea (75%)
43
Enlarged palatine tonsils are common, what are the grades?
Graded as 1+, 2+, 3+, 4+
* 1 + contained within the closet, don't extend beyond the fauscial pillars
* 2 + extend beyond the edge of the pillars, hide posterior pillar
* 3+ larger but not large enough to reach midline
* 4+ large enough to reach the midline (kissing tonsils)
- they do not have to be the same side
- sometimes they can be between two grades
44
What can happen with enlarged palatine tonsils?
* May cause a muffled resonance
* May cause the tongue to be postured down and forward
* Surgery usually has no effect on speech or it has a positive effect
45
How are pharyngeal tonsils graded?
Graded by similiar system
* 1+ = 25%
* 2+ = 50%
* 3+ = 75%
* 4+ = 100%
46
Enlarged Pharyngeal Tonsils-Adenoids
* May block eustachian tube orifice
* May cause hyponasality or NAE
47
When are adenoids sometimes removed?
Adenoids may be removed when
* enlarged with sleep apnea - 75% are removed for this reason
* Recurrent or persistent otitis media in children age 4 and older
* Recurrent sinusitis
48
What is Pierre-Robin Sequence?
| Not a syndrome - its a sequence
* Can also be caused by physical forces that inhibit mandibular growth in utero
* Includes micrognathia, glossoptosis, and often a characteristic U-shaped cleft palate
- A congenital condition that consists of micrognathia, glossoptosis, and cleft palate; there is often upper airway obstruction for several months after birth.
49
List five symptoms of VCF syndrome (22q11.2 deletion syndrome)
* velopharyngeal dysfunction
* congenital cardiac anomalies
* chronic middle ear effusion
* mild to moderate mental disability, specific learning disabilities, reading difficulties
* Psychiatric disorders
* Long narrow face, narrow palpebral fissues, Flattened malar eminence (cheekbone), a broad nasal root, a bulbous nasal tip, thin upper lip, often class II malocclusion
50
List 3 symptoms of Van der Woude Syndrome
* Cleft lip and/or cleft palate
* Bilateral lip pits on the lower lip
* missing teeth
* may have submucous cleft
51
Syndromes/sequence associated with cleft palate
* VCF syndrome
* Pierre Robin Sequence (can be part of syndrome, not a syndrome by itself)
* Stickler syndrome
- Fetal alcohol syndrome
- Beckwith-Wiedeman Syndrome
52
Stickler Syndrome indicators
* Eyes
* Ears
* Joint
* Sensorineural hearing loss
53
What are the classic symptoms of submucous cleft?
* Hypernasality
* Nasal air emission
* Comprensatory articulation errors
* Middle ear diease/hearing loss
* History of nasal regurgitation as an infant
* **Bifid uvula**
* **notching of palatine bone**
* **muscular diastasis of velum (division of muscle)**
* 25-50% have VPD
* about 50% or more will be asymptomatic
54
When is a submucous cleft palate repaired?
Surgical correction is considered only after speech has developed and velopharyngeal insufficiency has been diagnosed
55
Describe the impact of maxillary advancement on articulation and resonance
* The purpose of maxillary advancement is to bring the maxilla into proper alignment with the mandible, thus correcting the facial profile and the malocclusion
* the greater the advancement the greater the risk of VPD. Threshold = about 10 mm is a critical threshold.
* some studies show no relationship between advancement and speech
* Articulation generally improves or may be unchaged
* Phonemes most likely to improve include: /s, f, p, cg, sh/ and voiced cognates
56
Should all patients who anticipate adenoidectomy have an endoscopic exam for speech prior to surgery? Why?
a. No because there is too many of those surgeries that happen.
b. We know patients will have permanent VP issues 1:2000.
c. If there are red flags, then they should go to SLP prior.
- VP issues are caught that could impact child’s speech.
57
We have the primary palate and a secondary palate. Why is that important to know?
* They form on their own.
* You can have a cleft of the primary and not the secondary
- Its two different clefts.
- But about half the time whatever caused the first problem with cause issues in the secondary palate.
- 50% of the time there’s a cleft in both palates.
* 6-8 weeks primary palate forms, if it doesn’t fuse
* 8-10 weeks secondary palate, 2 week window for the processes to occur and the maxillary shelves to spring up and the tongue to get out of the way so that the palate can fuse.
58
Passavant's Ridge
A shelf-like ridge that projects from the posterior pharyngeal wall into the pharynx during speech; occurs as a result of contraction of specific fibers of the superior pharyngeal constrictor muscles; found in normal speakers and speakers with velopharyngeal dysfunction.
59
Ptosis
Drooping of the eyelid
60
Wardill-kilner V-Y pushback
* procedure where the inital incisions are similiar to those of the Von Langenbeck procedure except instead of leaving the mucoperiosteum attached in the front of the mouth, it is cut across as a V.
* The resulting open area is Y shaped, this frees up the mucoperiosteum of the whole palate and allows it to be pushed back in an attempt to lengtehn it.
* The levator muscle is still not address
* A high incidnece of anterior fistula's has been reported
61
Hypotelorism
Narrow spaced eyes
62
Hypoplastic
Underdeveloped or defective formation of a tissue or an organ
63
Microcephaly
Small **head circumfrance** in comparison to age-matched peers
64
Hypertrophy
Overgrowth of a structure
65
# VCF
FISH on 22q11
* Deletion of chromosome 22q11.2 with velocardiofacial/22q11.2 deletion syndrome
* With special techniques such as fluoresence in situ hybridization (FISH), submicroscopic segments of DNA can be identified using a fluorescent dye.
* Bloow draw
66
Corticotomy
A partial cut in the bone
67
Kernahan's Y
| Cleft
* Model uses a "striped-Y" figure as a means of identifying both the type and extend of the cleft
* The upper "arms" of the Y represent the incisive suture lines of the primary paalte
* The base of the Y represents the median palatine suture line of the secondary palate
* The center point where the arms and. the base connect represents the area of the incisive foramen.
68
Edentulous
Tooth loss
69
Diastema
Space or opening between the teeth, usually the middle teeth.
70
Intravelar veloplasty
A surgical reconstruction of the levator veli palatini sling during palatoplasty for correction of a cleft of the velum
71
Sequence
The occurrence of a pattern of anomalies that occur because of a single cause
72
Phenotype
The manifestations of a genotype; range of characteristics associated with a genetic syndrome
73
Hypertelorism
excessive distance between two paired organs, such as the eyes
74
Microtia
small or absent external ear or middle ear anomalies
75
Teratogen
External chemical or physical agents, such as cigarette smoke, drugs, viruses or radiation, that can interfere with normal embyrological developent and result in congenital malformations
76
Epicanthal Folds
Folds of skin extending from the root of the nose to the eyebrow and covering the inner corner of the eye. This is normal in the Asian population.
77
Nasal meatuses
The three passages in the nasal cavity that lie under a nasal concha
78
Dysmorphology
The study of abnormal shape or form
79
Endogenous
A factor from within the organism rather than from the environment, such as genetic makeup of the organism
80
Zona pellucida
A bluish area in the middle of the velum that is the result of abnormal insertion of the levator veli palatini muscles, effectively causing the velum to be thin and almost transparent in appearance
81
Z-plasty
A plastic surgery technique that is used to lengthen tissue
82
Rules of 10's
| Cleft lip specific
* 10 lbs
* 10 weeks
* 10 grams of hemoglobin
83
Cheiloplasty
Surgical modification of the lip
84
Crossbite
the maxillary tooth or teeth are inside the arch of the mandibular teeth
85
Macroglossia
Very large tongue
86
Variable expressivity
At time, may be difficult to distinguish between minimal expression caused by variable expressiviity and true incomplete penetrance
* Incomplete penetrance is the lack of a recognizable phenotype in an individual who carries a mutation that may cause an autosomal dominant trait or condtion
87
Palpebral fissues
Eye slits
88
Multifactorial inheritance
Some human disorders result from an interaction of multiple genes with environmental influences
"multiple factors"
89
Dehiscence
A breakdown of a surgical repair or an unwanted opening in an area that has been surgically closed
90
Diastasis
a separation between two normally joined structures, as in separation of the levator veli palatini muscles when there is a submucous cleft palate
91
Millard
Millard technique for repairing unilateral cleft lip
* Repaired in three layers from inside out; mucous, muscle and skin.
* the philtral ridge is lengthened by inserting a "patch" of tissue, inserted at the top of the lip, just beneath the nose
* Used in 80% of cases
92
Palatoplasty
plastic surgery for repair of the palate
93
Over bite
an overbite is when there is excessive overlap of the upper incisors over the lower incisors. An overbite is considered abnormal when the upper incisors overlap the lower incisors by more than 2mm or about 25%
94
Open bite
the maxillary teeth do not come together or occlude with the mandibular teeth
95
Craniosynostosis
Premature fusion of one or more cranial sutures, which causes the skull to grow abnormally
96
Levator veli palatini
Elevating the velum during velopharyngeal (VP) closure
"Levator is like an elevator and lifts the velum"
97
Superior constrictor
constricting the pharyngeal walls around the velum during VP closure
98
Tensor veli palatini
Opening the eustachian tube during swallowing
"ears are tense until the TENSOR opens the Eustachian tube"
99
Karyotype
A gross chromosome analysis that is done by drawing blood, growing cells in a culture, analyzing the white blood cells, photographing the chromosomes, and then arranging them in pairs for assessment
100
Craniosynostosis
the premature fusion of one or more cranial sutures, which causes the skull to grow abnormally
101
Surgical correction of submucous cleft is considered only after ________ ________ ________ and VP insufficiency has been diagnosed.
Speech is developed
102
The anterior point of the maxilla that corresponds to the base of the columella
Anterior nasal spine
103
The _____ ______ ___ muscles are responsible for opening the eustachian tubes in order to enhance middle ear aeration and drainage.
tensor veli palatini
104
The ____ muscles are responsible for the rapid downward movement of the velum for production of nasal consonants that follow an oral sound.
palatoglossus
105
The ____ muscles are responsible for the medial movement of the lateral pharyngeal walls to bring them against the velum.
palatopharyngeal
106
The ______ __ (also called superior pharyngeal constrictor) muscles are responsible for constriction of the lateral pharyngeal walls around the velum.
Superior constrictor
107
The levator muscles take up the midde % of the entire velum and, therefore, provide its main muscles mass
40
108
Because of the 45° angle, the contraction of the levator muscles pulls the velum in a ___ and ___ direction to close against the posterior pharyngeal wall. The point where these muscles interdigitate forms the velar dimple, which can be seen in the midline of the oral surface of the velum during phonation.
posterior, superior
109
Because of the 45° angle, the contraction of the levator muscles pulls the velum in a ___ and ___ direction to close against the posterior pharyngeal wall. The point where these muscles interdigitate forms the velar dimple, which can be seen in the midline of the oral surface of the velum during phonation.
posterior, superior
110
__________ ridge, first described by Gustav Passavant in the 1800s, is not a permanent structure. Instead, it is a defined area on the posterior pharyngeal wall that bulges forward inconsistently during velopharyngeal movement and then disappears during nasal breathing or when velopharyngeal activity ceases
Passavant's
111
__________ ridge, first described by Gustav Passavant in the 1800s, is not a permanent structure. Instead, it is a defined area on the posterior pharyngeal wall that bulges forward inconsistently during velopharyngeal movement and then disappears during nasal breathing or when velopharyngeal activity ceases
Passavant's
112
The _____ _____ consists of the velum (soft palate), lateral pharyngeal walls, and the posterior pharyngeal walls.
VP valve
113
The ________ (also called the pharyngeal tonsil, adenoid pad) consist of a singular mass of lymphoid tissue on the posterior pharyngeal wall, just behind the velum.
adenoids
114
throat area between the ____ and the ____ is called the pharynx.
nasal cavity, esophagus
115
The intraoral structures include the _______ , ______ ______ , _______ , ______ ______ , ______ _____ , ______ , and oropharyngeal isthmus
Tongue, faucial pillars, tonsils, hard palate, soft palate, uvula
116
An examination of the upper lip reveals the _______, which is a long dimple or indentation that courses from the columella down to the upper lip
philtrum
117
The ______ _________, also called nasal conchae (concha, singular), are paired bony structures within the nose that are covered with mucosa (FIGURE 1-6). They are attached to the lateral walls of the nose and protrude medially into the nasal cavity.
the nasal turbinates
118
the lower portion of the _____ fits in a groove formed by the median palatine suture line on the nasal aspect of the maxilla.
vomer
119
The _____ ______ is located in the midline of the nose and serves to separate the nasal cavity into two nostrils
nasal septum
120
The ______ _______ is the most anterior part of the nasal cavity and is enclosed by the cartilages of the nose.
nasal vestibule
121
The _______ is like a supporting column in that it provides support for the nasal tip.
columella
122
The ______ _____ ______ of the maxilla forms a base for the columella.
anterior nasal spine
123
The nostrils are separated externally by the _____ (little column).
columella
124
______ is a midline point just superior to the nasal root and overlying the nasofrontal suture.
nasion
125
The ____ ____ is the saddle-shaped area that includes the nasal root and the lateral aspects of the nose.
nasal bridge
126
The nose begins at the _____ _____, which is the most depressed, superior part of the nose and at the level of the eyes.
nasala root
127
The Eustachian tube connects the middle ear with the ________ and is ______ at rest but opens during swallowing.
nasopharynx, closed
128
Facial bones include the _____ bone that forms the cheeks and the ____, which forms the upper jaw, and then _____, which forms the lower jaw.
zygomatic, maxilla, mandible
129
the _____ suture is between the parietal, temporal, and occipital bones.
lamboid
130
The _______ suture crosses the skull vertically and, therefore, divides the two parietal bones.
sagittal
131
The _____ suture is across the top of the skull horizontally (like a crown) and separates the frontal bones and parietal bones.
coronal
132
The frontal bones are divided in midline by the ____ suture and bordered posteriorly by the _____ suture.
metopic, coronal
133
the ______ bone, which forms the back of the skull
occipital
134
the _____ bones, which form the sides and base of the skull
temporal
135
the ___ bone, which cover the top and sides of the cranium
parietal
136
Normal facial landmarks
137
an opening at the junction between the premaxilla and the maxillary bones.
incisive foramen
138
a triangular-shaped bone located in front of the maxillary bones
premaxilla
139
Where is the posterior nasal spine?
140
# Surgical repairs of the palate
The fisrt known surgical repair of the lip was in ________ 1622 years ago
China
141
In 1766 the first palate repair was attempted by a french dentist but _______
failed
142
What year was the first successful repair of the palate (velum only) done by a surgeon at Edinburgh University?
1819
143
Oral-nasal fistulas occur at 5-30%... what was the most common location?
at the junction of the hard and soft palate
144
How many kids (%) will have VPD after closure of the CL/P?
20%
145
Orthognatic Surgery (ABG or ACBG)
| Surgery that involves the bones of the upper jaw and the lower jaw.
* Bone graft to the alveolus
* maxillary osteotomy
* mandibular osteotomy
* advancement by distraction osteogenesis
BAMM
145
Orthognatic Surgery (ABG or ACBG)
| Surgery that involves the bones of the upper jaw and the lower jaw.
* Bone graft to the alveolus
* maxillary osteotomy
* mandibular osteotomy
* advancement by distraction osteogenesis
146
# Alveolar Bone Grafting
Rationale
* Provide bone for the eruption and/or orthodontic repositioning of teeth
* Closure of oro-nasal fistulas (the gap in the alveolus)
* Support and elevation of the alar base (the nose)
* Stabilization of the pre-maxilla in bilateral cases
- The pre maxilla may not be attached on either side
* Stabilizes the maxillary shelves in clefts of primary and secondary palate
147
Secondary bone grafting age
* Done before eruption of the permanent canine
* Usually when the root of the canine is 1/3 to 2/3 formed
* Usually between ages 8-10 but can be done earlier or later
* In CLP dental age is usually behind chronological age
148
Bone grafting site
* Autogenous Bone
- Usually the iliac crest
- Because that bones happens to match better than any other bone
* Also, calvarium, mandible
* Synthetic bones can also be used on a case to case basiss
- Usually smaller
149
What is one alveolar bone graft technique?
Pedicled finger flap to cover bone graft
150
True or False: Airway may be affected with mandibular setback
True but most people adapt
151
True or False: Facial skeleton is more important to SLPs than the cranium, but we still deal with some cranium disorders.
True
152
True or False: Congenital abnormalities of the mandible are rare.
True
153
True or False: The alveolar is the teeth bearing portion
True
154
True or False: Most clefts are seen in the maxilla
True
155
True or false: The palatine bone is the posterior part of the hard palate
True
| The anterior nasal spine is on the middle of the palatine bone
156
Where is the palatine bone?
157
Ethmoid forms the ____ of the nasal cavities
roof
158
Muscles of the velum
| elevators, depressors, etc
* Elevators
- Levator palatine
- uvulus
* Depressors
- palatoglossus
- palatopharyngeus
* Auditory tube dilator
* tensor palatine
159
True or False: CLP is a heterogeneous population
True
160
True or False: The younger the subjects the smaller the gap in language development
False: The younger the subject the greater the gap
161
True or False: Incident of language delay in CLP unknown but certainly higher than general population
True
162
True or False: There is a low incidence middle ear disease in CLP
False: there is a high inidence of middle ear disease in CLP
163
True or False: Incidence of middle ear disease is lower in children with cleft of primary palate only
True
164
True or False: Sensorineural hearing loss is expected in CLP and conductive hearing loss may be an indicator of a syndrome.
False: Conductive hearing loss is expected and sensorineural hearing loss may be an indicator of a syndrome.
165
Possible causes of middle ear disease
* MED is related to malfunction (and horizontal positioning) of the eustachian tubes
* Malfunction may be due to underdeveloped, missing, or poorly attached dilator muscles
166
True or False: The eustacian tube is twisted like a straw and the dilator muscles pull on one side and open the eustacian tube.
True
167
Treatment of MED
* Ventilation tubes
* Antibiotics
* Amplification (if there is hearing loss)
168
True or False: Younger kids with CLP are at a lower risk for conductive hearing loss.
False: Young = higher risk
* It improves with age
169
Is there a realtionship between hearing loss and type of palatal cleft?
No relationship with type of cleft as well as type of VP managment, type of surgery or age at time of surgery
170
True or False: a lot of middle ear infections are caused by the virus traveling across the eustachian tube and traveling to the middle ear from the pharynx
True
171
True or False: Feeding difficulties vary across different types of clefts
True
* Cleft lip only does not usually have significant feeding problems and breast feeding is possible
* Babies with velar cleft usually do not have a problem but the more extensive the cleft, the more likely problems will occur - babies with extensive clefts will not be able to breastfeed
* Feeding with cleft of hard and soft palate depends on extent and width of cleft
* Usually some difficulty with nipple compression and negative presure, feeding appliance may be helpful and breast feeding is not possible.
172
Types of special needs feeder
* Haberman bottle
* Mead-johnson bottle
* Dr. Brown bottle
173
Clefts of secondary palate
* Grade 0: SMCP characterized by classical triad of signs. Bifid uvula, bony defect of the hard palate. Muscular diastases
* Grade 1: Cleft extending in soft palate only
* Grade 2: Cleft extending less than 1/3 into the hard palate.
* Grade 3: Cleft extending more than 1/3 into the hard palate. But not reaching the foramen incisivum.
* Grade 4: Total, cleft extending to the foramen incisivium
174
Horizontal relationship of incisors
* Normaly the incisors have about 2mm of overjet
* More than 2 mm is excessive overjet
* Less than 2 mm is underjet
175
Posterior cross bite
* Normally, posterior maxillary teeth should overlap the mandibular teeth by 1/2 tooth
* The maxillary teeth may be in buccal or lingual cross bite
176
Developmental Terms
| Embryology
* Embryo: 0-8 weeks
* Fetus: 9 weeks to birth
* Neonate: Birth to one month
* Infant: Less than 2 years
177
Eye position's
| Embryology
* Primitive eye noticeable at 4 weeks
* Eyes are at 160 degrees at 6 weeks
* 120 degrees at 7 weeks
* 70 degrees at 10 weeks
* adult angle is 60 degrees
178
When is the first, second, third, and sometimes the fourth pharyngeal arch are visible externally?
5 weeks
179
True or False: The tongue has a groove in the middle before it merges
True
180
Salient features of orofacial exam
* eyes (hypertelorism, hypotelorism, epicanthal folds)
* Ears (microtia, atresia)
181
Orofacial exam things to look for
* Nose (bulbous tip, alar collapse, columella/philtrum)
* Lips (length/movement)
* Facial balance/symmetry
* Palate (fistulas/repairs)
* Velum (function, fistulas, submucous, tonsils)
* Dentition (teeth extracted, never erupted, no tooth buds)
* Tongue (ankyloglossia)
182
Ankyloglossia Dx
* Can not protrude tip beyond lower lip
- most kids sound okay acoustically because they are compensating
* Can not lateralize tip to corner of mouth
* Can not assume shape and/or position for /t, n, s, l, er, θ/ and voiced cognates
183
Genetics dominance describes?
a relationship between different forms of gene at a particular physical location on a chromosome.
184
Incomeplete penetrance
An individual who has the mutation (genotype) but lacks a recognizable phenotype
185
Variable expression
Degree of severity
186
Main features of Van der Woude syndrome
* cleft lip with or without cleft palate
* may be responsible for more cleft lip and palate than any other syndrome
* about 50% have CL and paalte
* Paramedian pits/protuberances of the lower lip
* Missing teeth (hypodontia) usually lateral incisors and molars
187
VCF: 90-95% have a mutation/deletion
(origin)
new
* hasn't occured in the family before
* * 9/10 are new mutation but it is passed on as autosomal dominant
188
True or False: All children with VCF appear to have some degree of disabilities
True
189
VCF: Up to % have VPD
90
190
VCF: Craniofacial/Oral findings
* overt submucous or occult submucous cleft palate
* structurally asymmetric face
* functionally asymmetric face
* vertical maxillary excess (long face)
* Frequent otitis media
* Sensorineural hearing loss (often unilateral)
* Prominent nasal bridge
* bulbous nasal tip
191
VCF: Speech/language
* severe hypernasality
* severe articulation impairment
* VP insufficiency (usually severe)
192
VCF: Cognitive/psychiatric
* learning disabilties
* ADD/ADHD
* bipolar
* schizophrenia
LABS
193
Robin Sequence Features
* retrognathia 1/3 normal size but the positioing is off
* micrognathia (small mandible caused by genetic or mechanical factor)
* glossoptosis (tongue is positioned too far back in the oral cavity)
* Velar cleft
* 50% or more have a syndrome (stickler, VCF, fetal alcohol syndrome)
194
Stickler syndrome salient features
* joints: hypermobile, arthritis
* eyes: near sighted, cataracts, glaucoma
* ears: SN hearing loss
* Robin sequence can co occur
195
Sticker features (other)
* midface hypoplasia
* vertebral anomalies
* epicanthal folds
* speech and hearing problems related to cleft and hearing
196
Fetal alcohol syndrome
* small head
* small stature
* upturned nose/pinna anomalies
* short palpebral fissures
* thin/flat upper lip
* mental impairment
* robin sequence with CP
197
Risk factors for VPD after adenoidectomy)
* Cleft or family history of cleft
* submucous cleft
* history of nasal regurgitation or sucking difficulty
* history of neuromotor dysfunction/delay
* moderate-severe phonological delay
* marginal VP function
198
Types of clefts
* incomplete CL
* unilateral cleft lip and alveolus
* unilateral CL and alveolus and lip pit
* unilateral complete lip and alvelous
* microform cleft lip
* bilateral cleft lip and alveolus
* microform cleft lip
* bilateral cleft lip and alveolus
* unilateral CL/P
* bilateral cleft palate
* midline maxillary cleft
* mandibular cleft
* bilateral macrostomia
* facial cleft
199
An ______ cleft (of the lip or palate) is one that does not extend all the way to the incisive foramen.
incomplete
200
A _______ cleft (of the lip or palate) is one that follows the embryological fusion line(s) and extends all the way to the incisive foramen.
complete
201
Orofacial clefts can be of the ________, ________, or _______.
lip only, the palate only, both
202
Beckwith-Wiedeman Salient features
(Everything's large)
* Large tongue, large eyes, large newborn size, organ enlargement
* Abdominal wall defects
* Microcephaly
* Hemihypertrophy
* Usually sporadiac, complex genetics
* 1/15,000
Usually normal development
