2.4 - Surgery Flashcards Preview

ECU Craniofacial Anomalies + Laryngeal Rehab > 2.4 - Surgery > Flashcards

Flashcards in 2.4 - Surgery Deck (42):
1

What does a PLASTIC/CRANIOFACIAL SURGEON do for individuals with craniofacial abnormalities?

(5)

Surgical repair of lip, palate, face

Nasal or ear deformities

Surgery for correction of VPD

Cranial surgery, bone grafts, + surgery on the jaws

Repair of defects, but also improvement of facial aesthetics, function, and speech

2

Will Plastic/Craniofacial Surgeon usually know about speech issues in children with craniofacial abnormalities?

(2)

No.

They will usually listen to SLP

3

When does the Primary (First) Lip Surgery occur for children with craniofacial abnormalities?

Around 3 months (10-12 weeks)

4

What must happen before the Primary (First) Lip Surgery for children with craniofacial abnormalities?

(2)

Child must have an established + successful feeding system

Child must show consistent weight gain/growth

5

What is the "Rule of 10" used to ok the Primary (First) Lip Surgery for children with craniofacial abnormalities?

Hemoglobin – 10 g/dl

Weight – 10 lbs (4.5 kg)

Age – 10 weeks old

6

What are the 6 goals for the Primary (First) Lip Surgery for children with craniofacial abnormalities?

Accurate membrane union

Symmetrical nasal floor

Minimal scarring

Normal philtrum

No alar collapse (sides of nose

Reapproxiamte obicularis oris

7

What 4 Pre-Surgical Management are preformed with individuals with craniofacial abnormalities?

Alignment of segments/tissue

Reduction of tension at site of cleft for lip, premaxilla
and prolabium

Non-surgical management techniques (lip taping, etc.)

Medical management techniques

8

What are 2 Medical Management Techniques for children with craniofacial abnormalities?

Pre-surgical orthodontics

Lip adhesion

9

What are the goals of Lip Taping for children with craniofacial abnormalities?

(5)

Done to decrease space between lateral segments

Releases tension across line of cleft

Improves flexion/pliability of soft tissue

Places premaxilla or prolabium back to position while maintaining remaining Maxillary segments

More success with taping, conservative approach

10

What is NAM (Nasoalveolar Molding) / Presurgical Nasal Alveolar Molding (PNAM)?

(2)

A device that expands tissues prior to surgery.

Used to approximate the cleft and mold the nose

11

What is a Latham Appliance Rotate Alveolar Segment? (2)

How often is it used?

An appliance that is surgically inserted by use of pins during the child's 4th or 5th month.

A screw must be turned daily to bring the cleft together to assist with future lip and/or palate repair

//

Used rarely in USA, never in UK

12

What is Pre-surgical Lip Adhesion for children with craniofacial abnormalities?

(4)

Modifies position of 2 or 3 segments of lip

Gluing or stitching segments together

Requires an additional surgery; additional anesthetic

Limited acceptance overall (due to extra surgery)

13

What are the 3 different types of surgical Lip Repair for children with craniofacial abnormalities?

Straight line repair (Rose-Thompson)

Triangular repair (Tennison, Skoog)

Rotational advancement (Millard)

14

What is a Logan Bar used for?

(2)

Post-op lip repair in children with craniofacial abnormalities

Used to reduce tension on surgical site

15

What are the 6 goals for Palate Repair for children with craniofacial abnormalities?

Closure (normal growth and speech)

Remove levator from hard palate and create muscular sling (to create movement)

Add bulk to velum body

Normal food intake

Decrease upper respiratory infections

Essentially to separate the oral + nasal cavities and increase velopharyngeal
competence

16

When is Palate Repair performed for children with craniofacial abnormalities?

(2)

Between 9-18 months

Usually between 12-15 months

17

What are the benefits of EARLY Palate Repair for children with craniofacial abnormalities?

Best chance for developmental speech production on par with peers

18

What are the benefits of LATE Palate Repair for children with craniofacial abnormalities?

Lowers risk of maxillary hypoplasia

19

What are the 3 different types of surgical Palate Repair for children with craniofacial abnormalities?

Von Langenbeck

Wardill-Kilner

Furlow Palatoplasty

20

What is the Von Langenbeck procedure?

(3)

A type of palate repair

Bipedicle

Elevation of mucoperiostium

(straight line)

21

What is the Wardill-Kilner procedure?

(4)

A type of palate repair

V-Y – Retropositioning/pushback

Unipedicle

Retropositioning

(Y-shaped)

22

What is the Furlow Palatoplasty procedure?

(3)

A type of palate repair

Double opposing Z-plasty

Lengthens velum

(overlapping of tissue flaps)

23

What are the 4 main guidelines for Post-Palatoplasty Care for children with craniofacial abnormalities?

Elbow restraints used to avoid movements that could potentially damage repair (No-nos)

Placed on clear diet; upgraded to pureed diet

Restricted from bottle feeds, pacifiers, nipples, or
spoons

Limited to use of cup-drinking for feeds

24

When is the Secondary Lip Surgery performed in children with craniofacial abnormalities?

(2)

Before going to school

Around 5 years old

25

What is the goal of the Secondary Lip Surgery for children with craniofacial abnormalities?

(3)

Reduce scar tissue on lip

Improve symmetry of vermillion border

Improve appearance and symmetry of nose

26

What is the goal of Secondary Nose Surgery for children with craniofacial abnormalities?

(2)

Lengthening columella (Cronin & Upton 1978)

Improve nasal airway

27

Why does the Columella need to be lengthened in children with craniofacial abnormalities?

(2)

Tends to be short in bilateral Cleft Lip

Improves size of nares

28

What is the name of the Secondary Nose Surgery for children with craniofacial abnormalities?

What does it do?

“Abbe flap” or “Cross-lip flap”

Transposes tissue from lower lip to upper lip where there is increased tightness

29

How often is Secondary Palate Surgery performed on children with craniofacial abnormalities?

In 20-30% of cases

30

When are secondary Secondary Palate Surgeries performed on children with craniofacial abnormalities?

(3)

Closure of palatal fistula or dehiscence

Correction of maxillary/mandible problem

Correction of velopharyngeal dysfunction (10-20%)
To decrease the size of the VP port during speech
To create a port that is sufficiently closed for speech
production but

31

What kinds of velopharyngeal dysfunction can be helped by Secondary Palate Surgeries?

(2)

To decrease the size of the VP port during speech

To create a port that is sufficiently closed for speech
production but open for breathing

32

What is a Palatal (oronasal) Fistula?

Where do they tend to occur?

A hole in the palate

Anteriorly

33

What can be caused by a Palatal (oronasal) Fistula?

(3)

Nasal emission (if small to
medium)

Hypernasality (if large)

Compensatory articulation

34

What are the 3 different types of Secondary Palate Repair for children with craniofacial abnormalities?

Pharyngeal flap

Sphincterpharyngoplasty

Pharyngeal Wall Augmentation

35

What is a Pharyngeal Flap Procedure?

Midline flap with lateral port control for breathing

36

Who is a good candidate for a Pharyngeal Flap Procedure?

(2)

Someone with good pharyngeal port movement but whose velum is still not making complete contact

Velopharyngeal gap is larger (>4mm)

37

What Complications may be seen after a Pharyngeal Flap Procedure?

(3)

Sleeping

Snoring

Anesthesia complications

38

What is a Sphincterpharyngoplasty?

Use of pharyngeal flaps to create a more narrow sphincter

39

Who is a good candidate for a Sphincterpharyngoplasty?

(3)

Someone with poor pharyngeal wall movement but who still has good overall velar movement

May still have inadequate mechanism

Velopharyngeal gap is smaller (<4mm)

40

What is a Pharyngeal Wall Augmentation?

(3)

Material injected into posterior pharyngeal wall

Placed deep within superior pharyngeal constrictors

Inititally overinjection is the goal due to absorption

41

What materials can be used in a Pharyngeal Wall Augmentation?

(6)

Cartilage

Fascia

Fat

Silicone

Proplast

Polytetrafluoroethylene (teflon)

42

Who is a good candidate for a Pharyngeal Wall Augmentation?

Velopharyngeal gap is typically small