Cleft Lip and Palate Flashcards Preview

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Flashcards in Cleft Lip and Palate Deck (66):
1

What is the male:female ratio for isolated cleft palate

0.0430555555555556

2

What is the male:female ratio for cleft lip, with or without cleft palate

0.0840277777777778

3

When is cleft palate repair performed

>6 months.

4

What is the incidence of cleft lip, with or without cleft palate, in term newborns

1 in 1000.

5

When is lip adhesion performed

2 - 4 weeks of age.

6

When does the primary palate develop

4 - 5 weeks gestation.

7

At what age is pharyngoplasty typically performed

4 years.

8

What is the chance of producing a cleft-lipped child when one parent is affected

4%.

9

When does the secondary palate develop

8 - 9 weeks gestation.

10

What % of children with cleft palate do not require tympanostomy tubes

8 - I 0°/o.

11

What is the most common facial cleft

A cleft uvula.

12

What is the difference between a complete cleft of the primary palate and that of the secondary palate

A complete cleft of the primary palate extends into the nose, is always associated with a cleft lip, and does not expose the vomer. A complete cleft of the secondary palate involves both the hard and soft palates, extends into the nose, and exposes the vomer.

13

What are the key features of the Millard cleft lip repair

A medial rotation flap to align the vermillion, a triangular C flap to lengthen the columella and an advancement flap to close the upper lip and nostril sill.

14

What is the role of palatal plates in the treatment of cleft palates

A palatal plate, when worn for 3 months prior to surgery and adjusted weekly to bring the palate and alveolus into a more normal shape, has been shown to lessen closure tension during surgery.

15

What is lip adhesion

A preliminary step in cleft lip repair where a complete cleft lip is converted into an incomplete cleft.

16

What is an incomplete cleft

A varying amount of midline mucosal attachment is preserved with an underlying muscular deficiency.

17

What is the most important factor in the aesthetic outcome of lip reconstruction

Alignment of the vermillion border.

18

How does the secondary palate develop

As a medial ingrowth of the lateral maxillae with fusion in the midline.

19

How does the primary palate develop

As a mesodermal and ectodermal proliferation of the frontonasal and maxillary processes.

20

At which points is the normal vermillion the widest

At the peaks of Cupid's bow.

21

When is alveolar bone grafting typically performed

Between ages 9 and I I.

22

What further facial deformities often occur as a child with a cleft palate grows

Collapse of the alveolar arch, midface retrusion, and malocclusion.

23

What sounds are most difficult for patients with cleft palate

Consonants, as they require full palatal lift.

24

What is the primary disadvantage of lip adhesion

Creates scar tissue that can interfere with definitive repair.

25

What is the significance of the timing of palatal repair on midfacial growth and speech

Earlier repair is associated with better speech but midface retrusion; later repair is associated with worse speech but minimal midface retrusion. More evidence exists to support the importance of timing on speech than on midface retrusion.

26

Which ethnic group has the highest incidence of isolated cleft palate

Equal incidence among racial groups.

27

T/F: A cleft lip is always associated with a cleft alveolus

False; but a cleft alveolus is always associated with a cleft lip.

28

For which types of clefts is the double reversing Z-plasty best

For narrow soft palate clefts and submucous clefts.

29

What are the boundaries of a unilateral cleft of the primary palate

From the incisive foramen anteriorly, between the canine and adjacent incisor to the lip.

30

What disorder should be suspected in children with cleft palate who fall below the 5t h percentile in growth

Growth hormone deficiency, as it is 40 times more common in this population.

31

What is the incidence of isolated cleft palate in term newborns

I in 2000.

32

When does midface retrusion present in children with cleft palate

In the teenage years when the growth spurt occurs.

33

What divides the palate into the primary and secondary palates

Incisive foramen.

34

What type of cleft is a submucous cleft palate

Incomplete cleft of the secondary palate.

35

What is the characteristic nasal deformity in a child with a unilateral cleft lip

Inferior and posterior displacement of the alar cartilage on the cleft side.

36

What are the indications for pharyngoplasty after cleft palate repair

Intractable VPI not responsive to speech therapy.

37

What is the term for repair of the levator veli palatini muscle during cleft palate repair

Intravelar veloplasty.

38

What are the major advantages of the Millard repair

It preserves cupid's bow and the philtral dimple, and by placing the tension of closure under the alar base, it reduces flare and promotes improved molding of the underlying alveolar process.

39

During embryologic development, what causes a cleft lip

Lack of mesodermal proliferation results in an incomplete epithelial bridge.

40

What artery runs through the incisive foramen

Lesser palatine artery.

41

What structures form the hard palate

Maxilla, horizontal process of the palatine bone, and the pterygoid plates.

42

How is midface retrusion treated

Maxillary advancement through LeFort osteotomies.

43

What happens to the soft palate muscles in a secondary cleft palate

Muscle fibers follow the cleft margins and insert into the posterior edge of the remaining soft palate.

44

What happens to the orbicularis oris muscle in a complete cleft lip

Muscle fibers follow the cleft margins and tenninate at the alar base.

45

What happens to the orbicularis oris muscle in an incomplete cleft lip

Muscle fibers remain continuous but are hypoplastic across the cleft.

46

Which ethnic group has the highest incidence of cleft lip

Native Americans.

47

What muscles form the soft palate

Palatopharyngeus, salpingopharyngeus, levator and tensor veli palatini, muscular uvula, palatoglossus, and superior constrictor muscles.

48

What are the most common environmental causes for clefts

Poorly controlled maternal diabetes and amniotic band syndrome.

49

What is usually the last surgery performed in children with clefts

Rhinoplasty.

50

Feeding difficulties are most severe with which type of cleft

Secondary palate clefts (either isolated or in combination with clefts of the lip and primary palate).

51

What strategies can be used to assist feeding with a cleft palate

Specialized nipples, upright feeding to minimize nasal regurgitation, palatal plates.

52

What was the first approach described for cleft lip repair

Straight line closure.

53

What are the 3 techniques most often used for unilateral cleft lip repair

Straight line repair, Tennison triangular flap repair, and Millard rotation advancement flap.

54

What are 2 techniques for pharyngoplasty

Superior based pharyngeal flap and sphincter pharyngoplasty.

55

What muscle is primarily responsible for preventing velopharyngeal insufficiency

Superior constrictor muscle.

56

What is Simonart's band

The bridge of tissue connecting the central and lateral lip in an incomplete cleft lip.

57

In a Millard repair, which part of the lip is rotated and which is advanced

The medial segment is rotated inferiorly, and the lateral segment is then advanced medially.

58

What are the 2 most common methods of secondary cleft palate repair

The V-Y advancement and the double reversing Z-plasty.

59

Which is best for clefts extending into the hard palate

The V-Y advancement.

60

What is the purpose of lip adhesion

To facilitate definitive repair by decreasing the tension across the wound.

61

What is the most common single gene transmission error causing clefts

Trisomy 21.

62

T/F: At no time in the development of the normal primary palate is there a separation

True.

63

What is the most common repair for complete unilateral cleft palate

Two flap palatoplasty, described by Bardach and Slayer.

64

What % of patients eventually require pharyngoplasty to reduce VPI

Up to 20%.

65

What are the 2 most commonly used classification systems for clefts

Veau and Iowa classifications.

66

When is a cleft lip normally repaired

When the child is I 0 weeks old, weighs I 0 lbs, and has a hemoglobin of I 0 ("rule of I O's"); this is delayed 4 months if lip adhesion is first performed.