Oral Cavity

Question 1

Cleft Palate

Answer 1

Primary- harelip. Lip and premaxilla.
Failure of palantine processes to unite medially
Secondary- cleft palate. Hard and soft palate.
Mesoderm fails to migrate between ectoderm. Harelip cosmetic only
Hinged flap (sandwich overlap) technique
Double layer closure
Sliding bipedicle flap technique
Mucoperisteal flaps

Question 2

Cleft palate pathophysiology

Answer 2

Oronasal reflux, rhinitis, unilateral or bilateral mucopurulent discharge, aspiration pneumonia.
Stunted growth

Question 3

hard palate blood supply

Answer 3

Minor and major palatine aa, infraorbital aa

Simple interrupted vs mattress. Electrocautery increases dehiscence

Question 4

Mucoperisteal flaps

Answer 4

Bipedical sliding- single and double layer closure.
Hinged/ Inversion
Rotating

Question 5

Sliding bipedicle flap technique- cleft palate

Answer 5

Lateral releasing incision
Subperiosteal elevation
Attempt to preserve GP artery
One layer- simple interrupted
Two- simple continuous covered by simple interrupted
Undermine and pull things together
Cut the edge of the flaps to initiate healing

Question 6

Double layer closure- cleft palate

Answer 6

hinged and sliding flap
Hinged inverted flap- simple cutaneous
Sliding advancement flap- simple interrupted

Question 7

Hinged flap (sandwich overlap) technique- cleft palate

Answer 7

Create recipient bed, make flap 2-3mm greater than defect.
Subperiosteal elevation, maintain attachment, simple interrupted or mayo mattress closure
Post op- Remove food debris and irrigate. Oral bypass?
Suture removal in 10 days.
Open palatine beds- epithelialize in 3-4 weeks

Question 8

Oronasal fistula

Answer 8

Sneezing, unilateral nasal discharge
Gingival- buccal single flap technique
Double (reposition) flap technique
Partial maxillectomy technique

Question 9

Gingival- buccal single flap technique- oronasal fistula

Answer 9

Sliding flap technique. Wide base 2x the defect. Subperiosteal elevation of gum and lip. Single layer simple interrupted closure.
Often with canine tooth extraction

Question 10

Double (reposition) flap technique- Oronasal fistula

Answer 10

Hinged mucoperiosteal flap: curved incision on hard palate, subperiosteal elevation to edge, hinged and sutured to lateral gingiva
Sliding gingival buccal flap- wise based subperiosteal elevation. Sutured to cut edge of hard palate mucoperiosteum

Question 11

Partial maxillectomy technique- Oronasal fistula

Answer 11

Excise incisive or palatine bone. Gingival- buccal or labial flap