Paediatric Plastics

Question 1

What is Craniosynostosis?

Answer 1

Premature fusion of one or more cranial sutures

Question 2

What is Virchow’s law in relation to craniosynostosis?

Answer 2

Premature suture fusion results in cranial growth predominately parallel to sutures (rather than perpendicular).

Question 3

Craniofacial Clefts

Question 4

Definition of Cleft Lip

Answer 4

Cleft lip is a congenital abnormality of the primary palate involving the lip, alveolus, and hard palate anterior to the incisive foramen. If extending posterior to the incisive foramen, it is termed cleft lip and palate (CLP).

Question 5

Definition of Cleft Palate

Answer 5

Cleft palate is aetiologically and embryologically distinct from CL and CLP, and represents a cleft of the secondary palate involving the hard palate (HP), posterior to the incisive foramen, and/or the soft palate (SP).

Question 6

Classification of Cleft Lip

Answer 6

General
Unilateral or bilateral: based on the whether the vomer is attached to one of the palatal shelves (i.e. unilateral CP) or neither of them (i.e. bilateral CP).
Complete or incomplete.
Based on supposed inheritance pattern:
- Non-syndromic C +/- CP.
- Non-syndromic CP.
- Syndromic CL with or without CP.
- Syndromic CP.

Veau’s classification (1931)
A Incomplete cleft of secondary palate.
B Complete cleft of secondary palate.
C Complete unilateral cleft lip and palate.
D Bilateral cleft lip and palate.

Question 7

Cleft lip/palate epidemiology

Answer 7

Most prevalent facial abnormality in the world. Incidence of 0.2–2.3 per 1000 births.

High: Asian 1:450
Intermediate: Caucasian 1:1000
Low: Black: 0.5:1000
Males (2:1)

Question 8

Cleft lip congenital associations?

Answer 8

Trisomy 13 (Patau’s syndrome) and trisomy 21.
Waardenburg’s syndrome.
Van der Woude syndrome (associated with lip pits).

Environmental factors:
- Alcohol.
- Anticonvulsants (e.g. phenytoin).
- Folic acid deficiency.
- 13-cis-retinoic acid.
- Tobacco.

Question 9

Normal facial development/ embryology

Answer 9

Face forms from five facial primordia: 1. Frontonasal prominence
2. Bilateral maxillary prominences
3. Bilateral mandibular prominences

Frontonasal prominence: Forehead, nose, and top of the mouth
Maxillary prominences: Lateral sides of the mouth

Lip formation occurs during weeks 4–7 of gestation

Question 10

Cleft Lip Embryology

Answer 10

CL results from failure of fusion of the medial and lateral nasal prominences (or processes) with the maxillary processes during week 5 of gestation. If associated with impaired palatal shelf fusion, CLP will result.

Question 12

Microtia

Question 13

Prominent Ear

Question 14

Types of Vascular Anomalies

Answer 14

Vascular Malformations
Vascular tumours

Question 15

Types of vascular tumours

Question 21

Congenital Nevus

Question 22

Common Congenital Hand Malformations

Answer 22

Syndactyly (1:2000)
Polydactyly
Bradydactyly
Mirror Hand
Central Hand deficiency
Symbrachydactyly
Clinodactyly
Kirner Deformity
Macrodactyly

Question 23

Brachial Plexus Birth injuries

Answer 23

Erb’s Palsy (C5-6): Upper Trunk Injury
Extended Erb’s Palsy (C5-7)
Global/total brachial plexus injury (C5-T1)
Lower Trunk (Klumpke’s) Injury (C8-T1)

Question 24

Classification of Nerve Injuries

Answer 24

Sunderland Classification
Neurapraxia (Sunderland type I)
Axonotmesis (Sunderland types II to IV)
Neurotmesis (Sunderland type V)
Avulsion

Question 25

Spina Bifida

Question 26

Paediatric Burns

Question 27

Toxic Shock Syndrome