Chapter Two

Question 1

What Is a Cleft?

Usually a _______
malformation due to abnormal fusion of parts during _______

Can be due to ______

Answer 1

Abnormal opening or fissure in an anatomical structure

congenital; embryological development

ablative surgery

Question 2

Clefts

Vary in ___and _____

Follow embryological _____lines

Answer 2

type

severity

suture

Question 3

Embryological Developmentof the Lip and Palate

Embryological development is dependent on formation of ______ cells in embryo.

Through the process of _______

Neural crest cells are found between the ____and the ____ of an embryo.

Cells migrate to form ______

Answer 3

neural crest

organogenesis

neural tube and epidermis

skull and face.

Question 4

Causes of Clefts

_____or ______factors delay cell migration and palatal shelf movement.

This can cause the embryo to miss the period of ______

Answer 4

Genetic or environmental

epithelial cell fusion.

Question 5

Causes of Clefts

Multifactorial Inheritance: Endogenous (internal) factors

Exogenous (external) factors (e.g., teratogens)

Answer 5

Chromosomal disorders
Genetic disorders

Drugs: phenytoin (Dilantin), valium, and corticosteroids

Viruses (rubella, influenza)

Teratogens (smoking, lead)

Nutritional deficiencies or maternal obesity

Mechanical interference

Question 6

Embryological Development***

Lip (primary palate)

Palate (secondary palate)

Development is _______.

Answer 6

begins at 7 weeks.

begins at 9 weeks.

independent

Question 7

Embryological closure begins at incisive foramen and “zips” …

Structures closest to the incisive foramen…

Answer 7

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

fuse first

Question 8

Embryological Development
Clefting severity occurs from…

____side of lip may close first.

_______ may close first.

Clefting starts in the strictures that are _____from the incisive foramen.

Answer 8

the lip in to the incisive foramen
the uvula in to the incisive foramen

Right

Oral surface of velum

farther

Question 9

Classification of Clefts
Primary Palate (Cleft Lip)

Fuses around ___weeks of gestation

______to incisive foramen

Includes ___and ____*** (can be one or both)

Clefts include:

Answer 9

7

Anterior

lip and alveolus

Complete or incomplete
Unilateral or bilateral

Question 10

Classification of Clefts
Secondary  Palate (Cleft Palate)

Fuses around ___weeks of gestation

_____to incisive foramen

Includes ___________

Clefts include:

Answer 10

9

Posterior

hard palate and velum

Complete or incomplete

Question 11

Unilateral incomplete cleft lip

Answer 11

Image

Question 12

Unilateral complete cleft lip

Answer 12

Image

Question 13

Bilateral incomplete cleft lip

Answer 13

Image

Question 14

Bilateral complete cleft lip

Answer 14

Image

Question 15

Clefts of the Primary Palate:Types and Severity

Simonart’s Band—

May be due to _____

Answer 15

band of soft tissue that bridges a cleft of the lip

amniotic bands

(Image)

Question 16

Clefts of the Primary Palate: Effects on Structure and Function

Structure
1.
2.
3.
4.

Function
1.
2.

Answer 16

1. Cleft lip and orbicularis oris
2. Wide, flat nose with spreading nasal ala
3. Short columella
4. Abnormal dentition
5. Specific articulation errors
6. Resonance affected

Question 17

Cleft palate

Answer 17

Image

Question 18

Cleft palate with Pierre Robin sequence

Answer 18

Image

Question 19

Bilateral complete cleft lip and palate

Answer 19

Image

Question 20

Fistula

Palatal (oronasal) fistula

Answer 20

Image

Question 21

Clefts of the Secondary Palate:Effects on Structure and Function

Structure

1. Absent _____
2. Altered insertion of the ________(cleft muscles of Veau)
3. Abnormalities in _____

Function

1. ______ insufficiency (speech and resonance affected)
2. _______problems and ____regurgitation
3. _______malfunction

Answer 21

1. velar aponeurosis
2. levator velar muscles
3. nasal septum

function

1. Velopharyngeal
2. Feeding; nasal
3. Eustachian tube

Question 22

Submucous Cleft Palate:Types and Severity

Overt—

Occult (hidden)—

Answer 22

visible from the oral surface

normal on the oral surface, abnormal on the nasal surface

Question 23

**Classic stigmata of an overt submucous cleft:

Bifid or hypoplastic:

Zona pellucida—

Notch in the hard palate where the posterior nasal ____should be, if the submucous cleft extends that far

Muscles often affected in the same way as a ______palate

Answer 23

Bifid or hypoplastic:(small and underdeveloped) uvula

Zona pellucida—thin, bluish area in middle of the velum

spine

complete cleft

Question 24

Submucous Cleft Palate

Answer 24

Image

Question 25

Submucous Cleft: Affects ______of the_______muscle Levator muscle inserts on the _____ border of hard palate rather than in the middle of the velum

Answer 25

interdigitation and levator veli palatini posterior (Image)

Question 26

Submucous Cleft: Effects on Structure and Function Depends on the ____ May have virtually no ____ May have the same effects as an overt cleft palate as follows: Structure Altered insertion of the ________ (cleft muscles of Veau)

Answer 26

extent effect levator velar muscles

Question 27

Function Velopharyngeal ______(speech and resonance affected) Feeding _____and nasal regurgitation Eustachian tube ______

Answer 27

Insufficiency problems malfunction

Question 28

Clefts of the Primary Palate:Types and Severity Midline cleft with holoprosencephaly Holoprosencephaly—

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. Image

Question 29

Facial Clefts: Type and Severity Can be caused by:

Answer 29

Genetic defects Amniotic bands

Question 30

Two types of facial clefts:

Answer 30

Oblique | Midline (median)

Question 31

Facial Clefts: Effects on Structure and Function Structural abnormalities on the outside the head (face or skull) usually suggest abnormalities on _________(face or skull).

Answer 31

the inside of the head

Question 32

Abnormalities on the inside the head (face or skull) usually affect function of the following:

Answer 32

``` cognition language speech resonance hearing feeding/swallowing ```

Question 33

Prevalence of Clefts*** Cleft lip occurs twice as often in ____(with/without cleft palate). Cleft palate occurs twice as often in ______.

Answer 33

males females

Question 34

Submucous cleft Facial cleft

Answer 34

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

Question 35

Treatment of Clefts

Answer 35

Cheiloplasty to close the lip Palatoplasty to close the palate Usually pharyngeal flap or sphincter pharyngoplasty if there is velopharyngeal insufficiency affecting speech

Question 36

Clefts are a common _________ Proper intervention is important.

Answer 36

birth defect.

Question 37

Velopharyngeal insufficiency*

Answer 37

VP closure is not achieved due to an anatomical In cleft palate, this is what we are talking about**

Question 38

VP incompetency*

Answer 38

results from a functional problem

Question 39

VP mislearning*

Answer 39

person incorrectly learns how to use sounds; anatomy and function are fine