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Craniofacial Anomalies > Week 2 - Part 2 > Flashcards

Week 2 - Part 2 Flashcards

Cleft lip / Palate Surgery

1
Q

Cleft lip / palate epidemiology facts

A
  • Unilateral:Bilateral - 9:1
  • L side:R side - 2:1
  • Most common in Asians (1:500) then whites (1:1000) then African Americans (1:2000)
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2
Q

chance of other kids having a cleft

A

CLP (one parent/child) - 4%
CLP (2 children) - 9%
CLP (1 parent & 1 child) - 17%

CP (1 kid) - 2%
CP (2 kids) - 1%
CP (1 parent) - 6%
CP (1 parent & 1 kid) - 15%

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3
Q

Multidisciplinary cleft care team includes…

A

-Plastic surgeon, dentist/oral surgeon, AuD, geneticist, nutritionist/dietitian, ENT, pediatrician, psychologist/social worker, SLP

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4
Q

Development of the primary palate

A

Forms from an internal swelling of the inter maxillary process (fusion of medial processes)
-Fusion of the medial nasal processes & the frontonasal process gives rise to the primary palate

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5
Q

Development of the secondary palate

A

Forms from the two lateral palatine shelves or processes - develop as internal projections of the maxillary prominences
-Fusion of the lateral palatine processes in the midline form the secondary palate

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6
Q

Oronasal development

A

Oronasal cavity is bounded ant. by primary palate & occupied by developing tongue - after development of secondary palate, the oral and nasal cavities can be distinguished - hardening of the palate involves withdrawal of tongue

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7
Q

Microform Cleft lip

A

Furrow / scar transgressing the vertical length of the lip - vermillion notch - imperfections in the white roll - variable distortion of the ala

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8
Q

Incomplete cleft lip

A

-Spares the superior aspect of the lip - orbit does not cross cleft unless cutaneous bridge at least 1/3 normal

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9
Q

Complete cleft lip

A

Lip, alveolus, and nose are all affected

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10
Q

Bilateral cleft lip

A

Over-projection of the pre maxilla and prolabium - broad, flat nasal tip, absent columella

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11
Q

Timing of lip closure: rule of 10’s

A

> 10lbs
10 weeks
Hgb > 10
*usually around 3 months

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12
Q

Pre-surgical NAM

A

Naso-alveolar molding - reduces the # of secondary surgeries required on nose - better results - neonatal cartilage is + plasticity & - elasticity - high levels of hyaluronic acid - high levels of circulating maternal estrogen
*Started ~1-2 weeks after birth

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13
Q

Advantages to post-natal lip repair

A

-baby carries mother’s immunity to infection, good healing mech, protection of maxillary segments from further distortion, improved feeding conditions, psychological benefit, reduction of cost from additional hospital stay

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14
Q

Contraindications to early surgery

A
  • More at risk for general anesthetic complications, preterm infants, severe anemia, jaundice, technically challenging
  • Proportion of blood loss is more significant for an infant
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15
Q

Cleft lip anatomy

A

-Premaxilla outwardly rotates/projected, lateral segment posterior, nasal spine in floor of the normal nostril, disruption of the orbicularis

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16
Q

Cleft side nasal deformity

A

Lower lateral cartilage attenuated, medial crus lower in columella, dome lower than normal side, lateral segment flat, spread across cleft at obtuse angle, alar base rotated outward in flare

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17
Q

Goals of lip repair (5)

A 
Reconstruct orbicularis musculature
Establish nasal base symmetry
Creata  symmetrical cupid's bow
Reconstruct vermillion & mucosal projection
Minimize scaring
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18
Q

What are the two main cleft lip repairs?

A
  • Millard Rotation-Advancement

- Tennison Triangular Flap

19
Q

Describe the Millard Rotation-Advance surgery

A

Medial lip element is rotated inferiorly and the lateral lip is rotates superiorly - columnar flap is used to create the nasal sil/base

20
Q

Where do you want the scar from a cleft lip surgery?

A

Along the philturn column so it blends

21
Q

Describe the Tennison (Triangular) Lip Repair

A

Medial lip is lengthened by incorporating a triangular flat from the inferior portion of the lateral lip - which leads into the philtrum

22
Q

Why are non-absorbable sutures used for lip repairs?

A

They are stronger & less reactive –> less scarring

23
Q

Timeline of treatment for cleft lip & palate - newborn

A

Diagnostic exam, general counseling of parents, feeding instruction, palatal obturator, genetic evaluation, prevention?

24
Q

Timeline of treatment for cleft lip & palate - 3 months

A

Repair of cleft lip - placement of myringotomy tubes

25
Q

Timeline of treatment for cleft lip & palate - 6 months

A

Pre-surgical orthodontics, first speech evaluation

26
Q

Timeline of treatment for cleft lip & palate - 9 months

A

Speech therapy begins

27
Q

Timeline of treatment for cleft lip & palate - 9-12 months

A

Repair of cleft palate

28
Q

Timeline of treatment for cleft lip & palate - 1-7 years

A

Orthodontic treatment

29
Q

Timeline of treatment for cleft lip & palate - 7-8 years

A

Alveolar bone grafting

30
Q

Timeline of treatment for cleft lip & palate - 8+ years

A

Continued orthodontic treatment, secondary surgery (columellar lengthening, cleft lip rhinoplastly & septoplasty, lip scar revision, LeFort I maxillary osteotomy)

31
Q

What are the main cleft palate repairs?

A

von Langenbeck Repair
Wardill-Kilner (V-Y Pushback)
Furlow

32
Q

Describe the von Langebeck Repair

A

Putting flaps along the cleft side & the lateral side and then advancing them together. Lateral side might get a gap, but the body will heal that gap

33
Q

Describe the Wardill-Kilner (V-Y Pushback) repair

A

It lengthens the palate - didn’t take good enough notes - check book

34
Q

Describe the Furlow repair

A

Mainly a soft palate repair - Double opposing ‘C’ palate surgery

35
Q

Alveolar Bone Grafting

A

Alveolar cleft HAS to remain in place until ~8-9 y/o due to mixed dentition period - spongey bone cells from the iliac crest are taken an dusted for the bone grafting at the alveolar ridge

36
Q

What is Distraction Osteogenesis?

A

Application of gradual & incremental traction to surgically separated bony segments to produce additional bone

37
Q

Describe distraction osteogenesis

A

1- bone separation (distraction zone)
2- Reparative callus formation in the distraction zone over 5-7 days (latency period)
3- Distraction forces applied to separate callus edges & elongate segment (activation period)
4-Consolidation period - stable over 8weeks

38
Q

Orthognathic Surgery

A

Surgical movement of the tooth-bearing segments involving the maxilla and the mandible

39
Q

What is Class I Occlusion?

A

Normal dentition

40
Q

What is Class II Malocclusion?

A

An overbite

41
Q

What is Class III Malocclusion?

A

Underbite

42
Q

What are other types of malocclusion (other than Class II and CLass III) (2)

A

Crossbite & Open bite

43
Q

What is LeFort Osteotomy?

A

LeFort spots are weak spots of the bone where you want to cut (due to least resistance)

44
Q

Rigid External Distraction (R.E.D)

A

Used for patients who need a cm+ of advancement of their upper jaw - once they make the cut, they put this device on and advance it 1mm at a time - soft tissue gets stretched gradually - wear for ~3 months - good results - less infection

Craniofacial Anomalies (4 decks)

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