Surgical Repair

Question 1

When is the outer lip repaired?

Answer 1

Rule of tens: 10 weeks of age, 10 pounds, 10 grams of hemoglobin

Question 2

What are the types of lip repair?

Answer 2

Straight line repair/lip adhesion(rose-thompson); Trangular flap (Randall-Tennison); millard rotation-advancement

Question 3

Does surgical repair of the lip help feeding?

Answer 3

No, is cosmetic. Improves bonding with extended family if child looks better.

Question 4

Is the Rose-Thompson lip repair/ straight line repair used anymore as the only surgery?

Answer 4

No, bad cosmetic outcomes. Sometimes used as preliminary before doing other surgery.

Question 5

What is the advantage of the tennison-randall or the millard repair?

Answer 5

Millard procedure: nose less likely to collapse

Tennison-randall: less pulling as scar contracts in healing

Question 6

When is a cleft palate usually repaired?

Answer 6

Usually before 12 months.

One stage: may be 10-24 months
Two stage: 12-24mo.

Question 7

Why are cleft palates repaired?

Answer 7

For speech.

Question 8

What are the different surgical repairs of the cleft palate?

Answer 8

Von langenbeck, v-y pushback, Furlow Z-Plasty, intravelar veloplasty (may be combined)

Question 9

What is a cleft lip repair called?

Answer 9

CHEILORRAPHY

Question 10

What is a cleft palate repair called?

Answer 10

Palatoplasty

Question 11

What are the drawbacks of the von langenbeck repair?

Answer 11

Does not address velopharyngeal muscles if done without combining with other treats= has high rate of velopharyngeal insufficiency`

Question 12

What are the drawbacks of a V-y pushback?

Answer 12

Has high rate of anterior fistulas, still may not address velopharyngeal muscles (but can)

Question 13

What is a intravelar veloplasty?

Answer 13

Meant to address the velopharyngeal muscles and be added to other cleft surgeries

Question 14

What are the drawbacks of intravelar veloplasty?

Answer 14

Has not seen very high success rates, some have found no difference in velopharyngeal function than without the procedure

Question 15

What is a z-plasty?

Answer 15

lengthens the tissue in the process of closing the cleft, and does it in a way that levator muscles overlap. Z shaped scar.

Question 16

What are the risks of a cleft palate repair surgery?

Answer 16

Dehiscence (breakdown of repair causing fistula or scarring). Blocked airway, excessive bleeding, continued dysfunction of the velopharygeal muscles and VP insufficiency

Question 17

Why is alveolar bone grafting used?

Answer 17

Close cleft in alveolus that would interfere with development of dentition/maloclusions

Question 18

How is an oralnasal fistula repaired?

Answer 18

Uses autogenous tissue first (person’s own). Flaps of tissue from turbinates, buccal mucosa, tongue

Question 19

What are the remittance rates for an oralnasal fistula repair?

Answer 19

37% or more

Question 20

When is alveolar bone grafting done?

Answer 20

6-11 years usually

Question 21

When is an oralnasal fistula repair done?

Answer 21

Often when alveolar bone graft is done.

Question 22

What is a feeding obturator?

Answer 22

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.

Question 23

What is often used in the case of wide clefts of the palate?

Answer 23

Create flap from nasal septum or tongue tissue

Question 24

What is a lefort 1 osteotomy used for?

Answer 24

Maxillary advancement when maxilla is underdeveloped. Most common LeFort

Question 25

What is LeFort 2 osteotomy used for?

Answer 25

Advancing both the maxilla and the bridge of nose forward when underdeveloped

Question 26

What is a LeFort 3 used for?

Answer 26

Advances whole face forward. Pretty rare.

Question 27

What impact does maxillary advancement have on speech?

Answer 27

Changes points of articulation, but usually does not impact articulation, can improve artic of some phonemes

Question 28

What impact does maxillary advancement have on velopharyngeal function?

Answer 28

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