Surgery

Question 1

Cleft palate’s most frequent effect is on ______

Answer 1

Speech

Question 2

NAM

Answer 2

Nasal-Alveolar Molding, other procedures to bring the cleft segments closer together. Frequently done with a passive device or molding plate that slowly changes the dental arch position by weekly adjustments to the plate.

Question 3

Straight Line Repair

Answer 3

Cut straight up

Question 4

Triangular flap repair (Tennison-Randall)

Answer 4

Or triangular flap procedure, is used in about 20% of the cases and follows from an older technique. It is precise and measured, and therefore it is often referred to as “cookie cutter” technique.

Question 5

Millard Rotation-Advancement Technique

Answer 5

also known as “cut as you go” to be one of the most difficult techniques. The tissue is inserted at the point of maximum tension where the underlying structures are relatively fixed to the maxilla.

Question 6

Palate Repair One Stage

Answer 6

Done around 10-24 months of age
Free Flap Repair
1. Furlow z-plasty for the soft palate- Some have reported better speech outcomes with this one. Involves reconstruction of the levator sling and lengthening the velum by closing it with opposing Z-plasties.
1. Von Langenbeck- one of the oldest and most successful means of palatal closure and is still popular today. In this repair and incision is made just inside the gum line, starting behind the area of the molars and extending up to the area of the canine tooth. The mucoperiosteum is carefully raised off the bone and, in conjunction with the velum, separated in one large layer.
1. V-Y retroposition procedure, aka Wardill pushback- A procedure were initial incisions are similar to that of the von Langenbek, except instead of leaving the mucoperiosteum attached in front of the mouth, it is cut across as a “V”. The resulting open area is “Y” shaped.
1. Vomer flap-

Question 7

Two Stage

Answer 7

Done around 12 and then 24 months

Question 8

Fistulae

Answer 8

Holes that develop after surgical repair
If a fistula has an effect on speech, eating, or drinking, as in air, food, or liquid gets into the nose, the fistula is said to be functional

Question 9

Orthognathic surgery

Answer 9

Bone graft to the alveolus.
Done when there’s a cleft in the alveolus
Timing of the bone graft is controversial
Generally, attempts are made to close fistulae at this time

Question 10

Maxillary osteotomy

Answer 10

Surgical repairs probably disrupt blood supply, nerve supply, growth.
Le Fort procedures
These procedures are done by an oral-maxillary surgeon.
Le Fort I
Le Fort II
Le Fort III – cranial surgeon
Maxillary advancement can create velopharyngeal dysfunction

Question 11

Mandibular osteotomy

Answer 11

Distraction osteogenesis