UCSF Cleft Palate

Question 1

The upper lip is formed by fusion of what processes?

Answer 1

Medial Nasal process and maxillary processes

Question 2

The frontonasal process gives rise to what other two processes?

Answer 2

(2) Medial Nasal processes

(2) Lateral Nasal processes

Question 3

The medial nasal processes give rise to what anatomic structures?

Answer 3

Bridge and Septum of the nose
Premaxilla
Philtrum

Question 4

The lateral nasal processes give rise to what anatomic structure?

Answer 4

Ala of the nose

Question 5

The primary palate is formed by what week? and from what processes?

Answer 5

By the 6th week

Two maxillary processes and the two Medial nasal processes

Question 6

The secondary palate is formed between what weeks? and from what processes?

Answer 6

between the 6-8th week

Formed by the two palatal processes which are outgrowth of the maxillary process

Question 7

By what week does the palate close?

Answer 7

Closes by 12 weeks

Question 8

When should the Cleft Lip repair occur

Answer 8

at 10 weeks, 10 lbs, Hb level 10

Question 9

At what week does a cleft lip form?

Answer 9

5 weeks

Question 10

When does a cleft palate repair occur?

Answer 10

10-18 months

- Close within first year of life to enhance normal speech development

Question 11

Alveolar bone graft should be performed in cleft palate when?

Answer 11

when canine root is 2/3 formed

Question 12

Second most common congenital disease after cleft lip/palate?

Answer 12

Hemifacial microsomia

Question 13

What type of clefting is associated with hypertelorism?

Answer 13

Midfacial clefts

Question 14

Bilateral cleft lip and palate is the result of failure of fusion of what?

Answer 14

Median and Maxillary process

Question 15

List common clinical side effects of cleft palate/lip

Answer 15

Rotated incisors
Missing Laterals
Posterior crossbite
Ectopic eruption
Supernumerary teeth

Question 16

What is not commonly seen in cleft palate/lip patients?

Answer 16

impacted canines

Question 17

What occurs in the upper facial height in cleft palate/lip patients?

Answer 17

Reduced upper facial height

Question 18

Infants with repaired lip and palate have deficiency of what?

Answer 18

Soft palate and likely VPI (velopharyngeal insufficiency)

Question 19

Explain how a cleft patient’s speech may be affected?

Answer 19

Inability to build up intraoral pressure due to communication between nasal and oral cavity

Question 20

What is the rule of 2/3 for cleft lip/palate?

Answer 20

2/3 are unilateral
2/3 are left side
2/3 are males

Question 21

List the cleft classifications

Answer 21

I - Soft palate only (21%)
II - Soft and hard palate (31%)
III - complete cleft palate and unilateral cleft lip (39%)
IV - bilateral cleft lip and palate (10%)

Question 22

Describe the time table for surgical procedures during cleft management

Answer 22

2-3 months: Lip closure
10-14 months: Palatal cleft closure
4-6 years: Pharyngeal flap procedure, Nasal correction and Lip revisions
6-10 years: Secondary alveolar bone graft + Orthodontics
13-18 years: Orthognathic Surgery, Septorhinoplasty
>18 years: Implants and other prosthetic procedure

Question 23

What is the “Rule of Tens”

Answer 23

Prior to lip closure in cleft patients, the child should weigh at least 10 lbs, have hemoglobin of at least 10 grams, have white count higher than 10,000, at least 10 weeks of age