inherited vs aquired
inherited: genes
aquired: overcrowding in womb, lack of folic acid
bones of hard palate
parts of soft palate
blood supply to palate
the major palatine does not have vein with it- because there is a venous plexus
why do you have problems with flaps in hard palete
no vein with major palatine artery
only venous plexus
- blood goes into flap but not out
what can cause aquired cleft palete
stress
lack of folic acid
steroids
overcrowding
primary palate is made of
lip and most rostral hard palate
- cleft lip (lip and rostral palate)
- hare lip (lip defect only, usually one sided)
secondary palate is made from
hard and soft palate
- hard palate: midline cleft
- soft palate: midline, unilateral, hypoplasia/aplasia- uvua like redudant/hanging)
how to get palate defect after birth
- chronic infection- servere dental disease, osteomyelitis
- trauma
- cancer
- sugery
- radiation
clinical sings for hard and soft palate defects
- Difficulty nursing, nasal reflux
- Nasal discharge, sneezing, rhinitis, tonsillitis
- Coughing, gagging, aspiration pneumonia
- Poor weight gain and general unthriftiness
how to repair oronasal fistula
- usually from dental disease (canine tooth)
- remove defect- expose healthy tissue
- make buccal/labial mucosa flap over defect with tension reliving by dissecting periosteum
- make base of flap wider then edge
why use overlapping flap
- Less tension on suture line
- Suture line not located directly over the defect
- Large opposing connective tissue surfaces
- Preferred for congenital primary and secondary palate defects and various acquired defects
how to do midline repair with overlapping flap
conserve accessory and major palatine artery from flap that is getting flipped over
- exposes bone
- done at 4 months- still growing, bone might slow done growth
how to do midline defect with medially positioned flap
- has more tension on suture lines
when to use
- for traumatic cleft palate
- Very narrow congenital cleft palate
- Soft palate clefts
when to use medially positioned flap technique
when to use
- for traumatic cleft palate
- Very narrow congenital cleft palate
- Soft palate clefts
how to do medially positioned flap technique for hard and soft palate
- repair up to caudal pole of tonsils
- no releasing incisons for soft palate- closed in two layers (nasopharyngeal then oralpharyngeal)
how to repair unilateral soft palate defect
- remove tonsil
- extend incision
- suture
do you use antibiotics for palate surgery
not usually
- can use for stomatitis, necrosis, eosinophillia
