Structural Flashcards
Types of velopharyngeal closure patterns: Coronal closure
movement is velum to PPW more velar closure/movement could be a functional or structural issue- Sphincter Phayngoplasty- taking portions of posterior and lateral PW and bulking it up to create extra tissue and close velopharyngeal port.
Types of velopharyngeal closure patterns: Sagittal
lateral wall closure=pharyngeal flap. Bridge to the velum and palate to get closure, functional issue- pharyngeal flap- take mucosal issue form PPW and insert it into the velum majority of closure with lateral walls.
Types of velopharyngeal closure patterns: Circular
all of it closes, a combination of the two lateral walls and posterior and velum all closing around the center. Could be a functional or structural issue - Sphincter Phayngoplasty
What is Laucial Coding
CAPS=complete Lower case= incomplete L-lips A- alveolar H- hard palate S- soft palate * submucosal cleft Doesn’t change following surgery
Malocclusions
- Normal occlusion
- Class I malocclusion
- Labioversion
- Torsiversion
- Class II malocclusion
- Overbite
- Class III malocclusion
- Underbite
Effects on social & educational
- No relationship between IQ and cognitive abilities and cleft
- Language learning
- Anything will be related to otitis media
- Will be treated differently
- Lower expectations
- Will advocate for nonsyndromic cleft
- Hospitalizations will cause them to miss school
What sentence for hyponasality
Mamma made lemon jam
What sentence for hypernasality
Papa plays baseball
Types of surgery
- Initial closer of lip- 6 weeks (raw edges put
- Initial closure of palate- 12-15 months
- Lip/nose revision in preschool years
- Alveolar bone grafting- age 9-10
- Lengthening of velum might be needed- puberty 9-10
- Surgical advancement of maxilla in teenage years
When and why do you do: Initial closer of lip
- 6 weeks, follow up at 3-4 months
- Closed for feeding
- 10 pounds 10 weeks 10 hemoglobin (10-10-10 Rule)
- 3-4 months use the name brand to take into consideration muscle orientation and reduce of scaring, allow them to lengthen the tissue
When do: Initial closure of palate
-12-15 months
Type of palate surgery
- Z plasty
- VY pushback
- Von Langenbeck
What is the lip/nose revision for and when is it done?
- Build nose so it is not flat
- Cheiloplasty - lip repair
- Symmetry
- Preschool years
When is Alveolar bone grafting done
Around age 9-10, wait because if done too early it can impede on development
What is the relationship between cognition and intelligence
- No difficulty with IQ or academic performance b/c of cleft
- Maybe when there is a disorder linked to the cleft, midline or otitis media
Muscles for innervating velar elevation
Levator veli palatini
Muscles for depressing
Palatoglossus and palatopharyngeus
What is the difference of objective and subjective
Subjective=Direct is what you see
Objective=Indirect is numbers
What are Indirect= objective measures
- Airflow
- Air Pressure
- Acoustic
- Nasalance
- Nasometry
- Aerodynamics
What are Direct=subjective measures
- Videofluoroscopy and nasoendoscopy
- Perceptual ratings- NOT RELIABLE
- Nasoendoscopy
What does a nasometer measures
oral nasal balance
What is resonance
perception
Nasal emssion is NOT
resonance
Why do clefts occur?
- Multifactorial
- Environment
- Chromosomal disorders
How does a cleft affect a person?
- Birth- adjustment, surgeries, bonding
- PreK- others will make comments
- School years- peer relationships, miss school due to surgeries
- Teens- self-concept, relationships, school achievement
- Adult- jobs, social, life partner
Types of Clefts
- Cleft Lip
- Cleft Palate
- Cleft Lip and Palate
- Unilateral
- Bilateral
- Complete
- Incomplete
- Submucous cleft
- Alveolar cleft
What is a Submucous cleft
- Blue tint and has a notch in hard palate
- Found in growth in development around age 9-10 in the school
- Refer to ENT
Advantages for a team approach
- Evaluate whole child
- Lower cost
- Shared decision-making
- Better follow-up
- Saves time
When do clefs occur?
First trimester
