Surgical Repair Flashcards
When is the outer lip repaired?
Rule of tens: 10 weeks of age, 10 pounds, 10 grams of hemoglobin
What are the types of lip repair?
Straight line repair/lip adhesion(rose-thompson); Trangular flap (Randall-Tennison); millard rotation-advancement
Does surgical repair of the lip help feeding?
No, is cosmetic. Improves bonding with extended family if child looks better.
Is the Rose-Thompson lip repair/ straight line repair used anymore as the only surgery?
No, bad cosmetic outcomes. Sometimes used as preliminary before doing other surgery.
What is the advantage of the tennison-randall or the millard repair?
Millard procedure: nose less likely to collapse
Tennison-randall: less pulling as scar contracts in healing
When is a cleft palate usually repaired?
Usually before 12 months.
One stage: may be 10-24 months
Two stage: 12-24mo.
Why are cleft palates repaired?
For speech.
What are the different surgical repairs of the cleft palate?
Von langenbeck, v-y pushback, Furlow Z-Plasty, intravelar veloplasty (may be combined)
What is a cleft lip repair called?
CHEILORRAPHY
What is a cleft palate repair called?
Palatoplasty
What are the drawbacks of the von langenbeck repair?
Does not address velopharyngeal muscles if done without combining with other treats= has high rate of velopharyngeal insufficiency`
What are the drawbacks of a V-y pushback?
Has high rate of anterior fistulas, still may not address velopharyngeal muscles (but can)
What is a intravelar veloplasty?
Meant to address the velopharyngeal muscles and be added to other cleft surgeries
What are the drawbacks of intravelar veloplasty?
Has not seen very high success rates, some have found no difference in velopharyngeal function than without the procedure
What is a z-plasty?
lengthens the tissue in the process of closing the cleft, and does it in a way that levator muscles overlap. Z shaped scar.
What are the risks of a cleft palate repair surgery?
Dehiscence (breakdown of repair causing fistula or scarring). Blocked airway, excessive bleeding, continued dysfunction of the velopharygeal muscles and VP insufficiency
Why is alveolar bone grafting used?
Close cleft in alveolus that would interfere with development of dentition/maloclusions
How is an oralnasal fistula repaired?
Uses autogenous tissue first (person’s own). Flaps of tissue from turbinates, buccal mucosa, tongue
What are the remittance rates for an oralnasal fistula repair?
37% or more
When is alveolar bone grafting done?
6-11 years usually
When is an oralnasal fistula repair done?
Often when alveolar bone graft is done.
What is a feeding obturator?
Prosthesis used by infants with cleft palates, blocks off part of the cleft so the baby can drink without putting the liquid into the nasal cavity. It is now considered not necessary in most cases.
What is often used in the case of wide clefts of the palate?
Create flap from nasal septum or tongue tissue
What is a lefort 1 osteotomy used for?
Maxillary advancement when maxilla is underdeveloped. Most common LeFort
What is LeFort 2 osteotomy used for?
Advancing both the maxilla and the bridge of nose forward when underdeveloped
What is a LeFort 3 used for?
Advances whole face forward. Pretty rare.
What impact does maxillary advancement have on speech?
Changes points of articulation, but usually does not impact articulation, can improve artic of some phonemes
What impact does maxillary advancement have on velopharyngeal function?
Can advance up to about 10mm with most likely no effect. > 10 moves velum forward, risk for VPD.
The greater the advanced, the greater the risk for VPD
