Ch. 2

Question 1

What is a cleft?
-Abnormal _______ or fissure in an anatomical structure
-Usually a _______ _______ due to abnormal fusion of parts during embryological development
-Can be due to ________ surgery
-Vary in ________ and __________
-Follow _________ __________ lines
Length of ____________ suture line.

Answer 1

-Abnormal opening or fissure in an anatomical structure
-Usually a congenital malformation due to abnormal fusion of parts during embryological development
-Can be due to ablative surgery
-Vary in type and severity
-Follow embryological suture lines
Length of medial suture line.

Question 2

Embryological Development is dependent on the formation of _______________.

Answer 2

neural crest cells in embryo

Question 3

Where are neural crest cells found?

Answer 3

between the neural tube and the epidermis of an embryo

Question 4

Cells migrate to form ______.

Answer 4

skull and face

Question 5

Causes of clefts:

• _________ or ________ factors delay cell ___________ and palatal shelf movement.
• This can cause the embryo to miss the period of _________ _________fusion.

Answer 5

• Genetic or environmental factors delay cell migration and palatal shelf movement.
• This can cause the embryo to miss the period of epithelial cell fusion.

Question 6

Multifactorial Inheritance: Endogenous (internal) factors

Answer 6

Chromosomal disorders

Genetic disorders

Question 7

Multifactorial Inheritance: Exogenous (external) factors

Answer 7

Drugs: phenytoin (Dilantin), valium, and corticosteroids
Viruses (rubella, influenza)
Teratogens (smoking, lead)
Nutritional deficiencies or maternal obesity
Mechanical interference

Question 8

Lip (primary palate) begins at

Answer 8

7 weeks

Question 9

Palate (secondary palate) begins at

Answer 9

9 weeks

should be finished by 12 weeks

Question 10

Embryological closure begins at
_______ ___________ and “zips” …
-____________ to form the alveolar ridge and then lip
-____________ to form the hard palate and velum

Answer 10

incisive foramen and “zips” …

• forward to form the alveolar ridge and then lip
• backward to form the hard palate and velum

Question 11

Clefting Severity occurs from
the _______ in to the incisive foramen
the ________ in to the incisive foramen

Answer 11

the lip in to the incisive foramen

the uvula in to the incisive foramen

Question 12

right side of the lip

Answer 12

may close first.

Question 13

Oral surface of the velum

Answer 13

Oral surface of velum may close first.

Question 14

Primary Palate (Cleft Lip)
Fuses around \_\_\_ weeks of gestation
  \_\_\_\_\_\_\_\_ to incisive foramen
  Includes \_\_\_\_\_\_\_ and \_\_\_\_\_\_\_\_\_
  Clefts include:
\_\_\_\_\_\_\_\_ or \_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_ or \_\_\_\_\_\_\_\_\_\_\_

Answer 14

Fuses around 7 weeks of gestation
  Anterior to incisive foramen
  Includes lip and alveolus
  Clefts include:
Complete or incomplete
Unilateral or bilateral

Question 15

Secondary Palate (Cleft Palate
Fuses around \_\_\_ weeks of gestation
  \_\_\_\_\_\_\_\_ to incisive foramen
  Includes \_\_\_\_\_\_\_\_\_\_\_ and \_\_\_\_\_\_\_\_
  Clefts include:
\_\_\_\_\_\_ or \_\_\_\_\_\_\_\_\_\_\_\_\_\_

Answer 15

Fuses around 9 weeks of gestation
  Posterior to incisive foramen
  Includes hard palate and velum
  Clefts include:
Complete or incomplete

Question 16

identify cleft lips and palates

Answer 16

see photos from powerpoint

Question 17

Simonart’s Band

Answer 17

band of soft tissue that bridges a cleft of the lip

May be due to amniotic bands

Question 18

Primary Palate: effect on structure
Cleft \_\_\_\_\_\_ and orbicularis oris
Wide, \_\_\_\_\_\_\_ nose with spreading nasal ala
Short \_\_\_\_\_\_\_\_\_
Abnormal \_\_\_\_\_\_\_

Answer 18

Cleft lip and orbicularis oris
Wide, flat nose with spreading nasal ala
Short columella
Abnormal dentition

Question 19

Primary Palate: effect of Function
Specific ________ errors
_________ affected

Answer 19

Specific articulation errors

Resonance affected

Question 20

Secondary Palate: effect on structure
Absent ____ _________
Altered ______ of the levator velar muscles (cleft muscles of Veau)
Abnormalities in ______ _________

Answer 20

Absent velar aponeurosis
Altered insertion of the levator velar muscles (cleft muscles of Veau)
Abnormalities in nasal septum

Question 21

Secondary Palate: effect on Function
_________ ____________ (speech and resonance affected)
Feeding problems and ______ ________
_______ _________ malfunction

Answer 21

Velopharyngeal insufficiency (speech and resonance affected)
Feeding problems and nasal regurgitation
Eustachian tube malfunction

Question 22

Submucous Cleft: Overt

Answer 22

visible from oral surface

Question 23

Submucous Cleft: occult

Answer 23

normal on the oral surface, abnormal on the nasal surface

Question 24

Classic Stigmata of an overt sub mucous cleft

• _______ or hypoplastic (small and underdeveloped) uvula
• ______ _________—thin, bluish area in middle of the velum
• _______ in the hard palate where the posterior nasal spine should be, if the submucous cleft extends that far
• Muscles often ______ in the same way as a complete cleft palate

Answer 24

• Bifid or hypoplastic (small and underdeveloped) uvula
• Zona pellucida—thin, bluish area in middle of the velum
• Notch in the hard palate where the posterior nasal spine should be, if the submucous cleft extends that far
• Muscles often affected in the same way as a complete cleft palate

Question 25

Submucous cleft: Affects _______ of the levator veli palatini muscle Levator muscle inserts on the _____ ______ of hard palate rather than in the _____ of the ______

Answer 25

Affects interdigitation of the levator veli palatini muscle | Levator muscle inserts on the posterior border of hard palate rather than in the middle of the velum

Question 26

Submucous Cleft effects on structure Depends on the ______ May have virtually ___ ______ May have the same effects as an _____ cleft palate as follows: Structure Altered ______ of the levator velar muscles (cleft muscles of Veau)

Answer 26

Depends on the extent May have virtually no effect May have the same effects as an overt cleft palate as follows: Structure Altered insertion of the levator velar muscles (cleft muscles of Veau)

Question 27

``` Submucous Cleft effects on function _________ ___________ (speech and resonance affected) Feeding problems and _______ _________ _______ _________ malfunction ```

Answer 27

``` Velopharyngeal insufficiency (speech and resonance affected) Feeding problems and nasal regurgitation Eustachian tube malfunction ```

Question 28

Holoprosencephaly: failure of the ____________ (the embryonic forebrain) to divide into _______ ________ of the cerebral hemispheres. The result is a _______-________ brain structure.

Answer 28

failure of the prosencephalon (the embryonic forebrain) to divide into double lobes of the cerebral hemispheres. The result is a single-lobed brain structure.

Question 29

Facial Clefts can be caused by

Answer 29

genetic defects | amniotic bands

Question 30

Two types of facial clefts

Answer 30

Oblique: slanting Midline: middle of the face

Question 31

Facial clefts effects on structure and function Structural abnormalities on the ______ the head (face or skull) usually suggest abnormalities on the ______ of the head (face or skull). Abnormalities on the ______ the head (face or skull) usually affect function of the following: _________ _________ _________ _________ _________ _________/___________

Answer 31

``` Structural abnormalities on the outside the head (face or skull) usually suggest abnormalities on the inside of the head (face or skull). Abnormalities on the inside the head (face or skull) usually affect function of the following: cognition language speech resonance hearing feeding/swallowing ```

Question 32

Cleft lip occurs...

Answer 32

twice as often in males (with or without cleft palate

Question 33

Cleft palate occurs...

Answer 33

twice as often in females

Question 34

Submucous cleft prevalence

Answer 34

Essentially unknown May not cause problems with speech May become symptomatic after adenoidectomy

Question 35

Facial Cleft prevalence

Answer 35

very rare

Question 36

TX of clefts: cheiloplasty

Answer 36

to close the lip

Question 37

TX of clefts: palatoplasty

Answer 37

to close the palate

Question 38

TX of velopharyngeal insufficiency affecting speech

Answer 38

pharyngeal flap or sphincter pharyngoplasty