Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Oral Surgery > Cleft 11/26 > Flashcards

Cleft 11/26 Flashcards

1
Q

1925-1950?

A

designing a surgical procedure to establish better anatomic result

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

1960 to present?

A

emphasis placed on etiology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

speech and swallowing function of? general

A

soft palate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

submucous cleft

general

A

in the muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

vascular deformaties within this scope

A

yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

incidence of cleft lip or cleft lip and palata

A

caucasian 1 in 1,000 births

blacks 1 in 2000

asains 1 in 500 births

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

incidence in cleft palate only

A

1 in 2000 births

isolated clefft palate is not ratiall influenced

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

is cleft palate only racial influenced?

A

no

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

incidence of clefting in USA

due to?

A

1 in 750 births

this is the overall ratio of clefts occurring in the USA

due to mixed gene pool

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

developing countries incidence

A

some locations increases to 1 in 350

involves different contaiminents

  • environmental and health issues
  • needs are greater
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

relative in family that has a cleft? incidence?

A

increases
the 750 incidence increases

genetic – incidence of future clefting is evident

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

palate alone with femal male

A

2:1
female to male

so female isolated palate

so female to male ratio is very different for the isolated cleft palate patient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

incidence with genetics

A

less than 40% of CL alone or CL/P deformities are genetic origin

less than 20% of isolated CP deformatities are of genetic origin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

NUTRIOTION ?

A

yes – FOLIC ACID DEFICIENCY – neural tube deformaties

food chain contaminatnts

  • insecticides – DDT
  • defoliants (agent orange)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

NUTRIOTION ?

A

yes – FOLIC ACID DEFICIENCY – neural tube deformaties

food chain contaminatnts

  • insecticides – DDT
  • defoliants (agent orange)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

etiology breakdown

A 
heredity 
parental age
maternal factors
nutrition
tetragogenic drugs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

etiologc maternal factors

A

hyperemsis – underlying medical problem

threatened abortion- underlying medical problem

measles

stress - endogenous cortisone release

smoking – pregnant women who smoke, and whose fetus carries a particular gene, may be increasing their chances that the baby will be born with a cleft palate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

drugs involved in etiology

A

salicytates

cortisone

barbiturates

dilantin

benzodiazepines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

at 8 weeks?

A

the cleft lip deformaty is complete

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

cleft lip and alveouls deformity complete at?

cleft palate deformity complete at?

A

cleft lip and alveolus = 8 weeks

cleft palate deformity = 11 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

feeding and airway concerns

general

A

early on these are big problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

implication on ear?

A

yes – eustachian tube openings

96% of all cleft children will have MIDDLE ear problem
- altered relationship b/w the tensor and levator muscles and the opening of the eustachian tubes

prone to fluid buildup and infections

cannot equalze pressure in middle ear

treat with placement of myringotomy tubes

hearing loss a real problem *

23
Q

with feeding what is a common problem?

how to manage

A

aspiration is a common problem

  • semi-upright position
  • soft lamb niples
  • enlarge nipple opening with an X
  • syringe or nasogastric tube (rare)
  • hyperalimentation (rare)
24
Q

manage at baby age of cleft patient

A

appliance
- passive - using an obturator

active
- orthopedic – appliance

25
manage at baby age
appliance - passive - using an obturator -- closes the whole active - orthopedic -- appliance
26
orthopedic appliance because
no teeth yet -- to move the alveolus segment without the tooth yet ACTIVE -- MOVES SEGMENTS - regular remodeling needed for all appliances to compensate for movement and growth
27
appliance technique
custom trey impression technique with the guaze rap around impression taken soon after birth insert appliance within first 24 to 8 hours
28
airway problem with these patients
usually only a problem in pierre robin patients face down position tongue/ lip adhesion surgery nasogastric tube as an airway tracheotomoy - try to avoid
29
active appliance uses
orthopedic movement - fits on the alveolus - mechanically move it regular remodeling needed to compensate for movement and growth
30
latham appliance is a type of
active and fixed can be unilateral or bilateral (can attempt to bring pre-maxilla back into place) use pins and put into the maxillary palate makes closing the whole in future surgeries easier because bringing the pieces closer together
31
NAM
nasoalveolar molding - improve the nasal anatotmy and the alveoulus active but removable like the other ones but with nasal components secured with to face with elastics and tape sleeps and eats with it change tape everyday
32
NAM objectives
reduce the severity of cleft lip, nose, and alveolus prior to surgical repair 1. approximate lip segments 2. decrease nasal base width 3. achieve convexity of nasal cartilages 4. elongate the columella (of nose) 5. approximate alveolar segments
33
standard approach in surgical management | can do it when? start with?
1. close lip at birth - rule of 10's (10 weeks old 10 lb 10 grams hemoglobin) -- can do the surgey 2. close hard and soft palate at 18 months 3. pharyngeal flap at 5 years for speech 4. alveolar cleft bone graft prior to cuspid eruption at about 7-9 years 5. orthognathic surgery 14-18 years old 6. cosmetic surgery - 21 years (lip reversion, rhinoplasty, etc)
34
after close lip? next? when?
18 months - close the palate
35
primary goals for cleft lip surgey
establish good lip form establish good lip function restore nasal form restore good facial contour
36
primary goals of cleft palate surgery
establish competent velopharyngeal (soft palate and pharynx function) mechanism separate oral from nasal cavities - for improved speech and deglutition improved eustachian tube function - to preserve hearing preservation of facial growth - esthetics allow for a functional occlusion / esthetic dentition
37
one sibling one parent sibling and parent for CL/P or CP
predicted increases in occurence rate of clefting in families where relatives have the deformity one sibling and one parent lower than if sibling and parent
38
male vs female with cleft lip or cleft lip/ palate vs cleft alone
cleft palate alone = 2:1 female cleftin alone is 20% male and 12% female cleft lip /palate is 48% male and 20% female basically the opposite for cleft palate alone with 2:1 female these show 2:1 for male
39
nutritional defomrity that is key in deformaties
folic acid - neural tube deformaties
40
timeline in cleft lip or alveolus
MP starts medial movement at 5 weeks at 6 weeks MP and MNP reach each other LNP= superior to become alar of nose at 6 weeks
41
MNP gives rise to
lip, alveolus, and primary palate (CL/ ALV form at junction of MNP ad MP)
42
formation of CL and ALV when?
ENTIRE PROCESS IS COMPLETE AT 8 WEEKS
43
muscle layer of the lip comes from?
MESODERM - therefore the mesoderm must migrate under the epithelium to prevent the epithelium from breaking donw and forming a cleft
44
mesoderm importtance and epithelium?
the MESODERM MUST MIGRATE COMPLETELY ACORSS TEH JUNCTION BETWEEN THE MNP AND MP at the 6-8 WEEK so the MESODERM SOLIDIFIES THE JUNCTION
45
cleft lip deformity at what stage? palate?
lip = 8 weeks in utero palate = 11 weeks in utero
46
formation of the palate and implication
tongue lies between the two palatal shelves in utero as head of fetus begins to straighten at about 10 weeks -- tongue drops down this allows palatal processes to meet in the midline with the VOMER VOMER + 2 PALATAL PROCESS = TRIPARTITE mmetting and forms PALATE and is complete at 11 WEEKS IN UTERO
47
implication of ealy developmental deformity
nutrition is key | but may not even know pregnant at 8 weeks and 11 weeks
48
confirmation of clefting
ultra sound can confirm -- can notice this on the ultra sound
49
non surgical care of cleft patient
MULTIPLE DISCIPLINE - genetic counseling - parental care - pediatrics - nutrition / feeding - audiology - speech pathology - orthodontics
50
breast feeding?
YES - this works | - the breast obturates the cleft and allows for the sucking action
51
millard technique aka and used for?
rotation and advancement flaps - for cleft lip surgery 1. mobilize skin, musle, and mucosa 2. close in three layers without tension - mucosa, muscle over and skin
52
implication of bilateral lip surgery
NO MESODERM in the prolabium and therefore no muscle in this section - the muscle turns superiorly and fuses with the piriform aperture no muscle so big stretch involved to bring across need to have muscle on one side attaching to muscle on the other side
53
palatal closure techniques
1. von langenbeck - horshoe shaped oral layer flap 2. push back tech 3 .furlow technique 4. vomer flap procedure need two layers in nose and mouth soft palate - 3 layers - the two plus a muscle layer
54
surgical closure of cleft palate technique
1. identify the extent of the deformity 2. identify usable tissue 3. develop and mobilize flaps - 2 in hard palate (nasal and oral layers) - 3 in soft palate (nasl, muscle, and oral) 4. reorient muscle in soft palate and close in layer without tension

Oral Surgery (26 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions