Orthognathic/Craniofacial/OSA Flashcards Preview

ABOMS (Johnston) > Orthognathic/Craniofacial/OSA > Flashcards

Flashcards in Orthognathic/Craniofacial/OSA Deck (44)
Loading flashcards...

Describe APGAR score

Apgar scores of 0-3 are critically low, especially in term and late-preterm infants

Apgar scores of 4-6 are below normal, and indicate that the baby likely requires medical intervention

Apgar scores of 7+ are considered normal (1, 3)


Incidence of CLP per 1000

  • Asian 3.2
  • Caucasian 1.4
  • African 0.43


What gestational age can CLP be diagnosed

16 weeks via ultrasound


What screening tool should be employed for infant with CLP


R/o valve disease or great vessel transposition


CLP laterality prevalence

2:1 on left


When does cleft lip (CL) develop

During 3rd-7th weeks


When does cleft palate form?

During 5th-12th weeks


What processes fail to fuse in CL?

CL = failed fusion of medial nasal and maxillary processes



What fails to attach / align in CP?

CP = failed attachment and alignment of levator veli, tensor veli palatini, uvular, palatopharygeus, and palatoglossus muscles


What forms primary palate? Secondary Palate?

Primary palate = premaxila = lip, alveolar arch, palate anterior to incisive foramen

Secondary palate = hard and soft palates posterior to incisive foramen


Rule of ten's for safe infant anesthesia

  • 10 weeks old
  • >10lbs
  • Hg >10


When is primary lip repair performed?

Advantages for later repair?

10-14 weeks

  1. More prominent landmarks
  2. Easier
    1. Better esthetic outcome


When is CP repair done?

What developmental milestone guides timing?

What are advantages for later repair?

9-18 months

Speech development. If child has mental delay and speech is anticipated much later, than CP repair should be delayed

  1. Decreased incidence of maxillary hypoplasia


What is incidence of VPI following CP repair?

20% VPI

diagnosed 3-5 years old


When is alveolar grafting performed?

Mixed dentition age 8-11

Canine root 2/3 formed


When is orthognathic surgery performed

If needed it is done age 14-18


When is lip and nasal revision surgery done?

After age 5 and only for severe deformities


What is most common technique for unilateral CL repair?

Millard rotation-advancement technique

  • 3 layers
  • Orbicularis oris muscle is made to form continous sphincter
  • Incisions lie in natural contours



When is rhinoplasty done?

6-12 months after orthognathic surgery, if needed. This is because maxillary advacement often improves nasal esthetics.


What can be done during CL repair to lengthen columella or create nasal sill?




Upper facial 1/3 exam

  • Female eyebrow form/dimensions
  • Superior orbital rim relation to cornea

  • Female eyebrows slope upward, peaking about 10 mm above the supraorbital rims
  • The superior orbital rims should project about 10 mm in front of the cornea


  • Normal nasolabial angle
  • Lateral orbital rim relation to cornea

  • 100 +/- 10. Greater in females
  • 10mm posterior to cornea


  • Upper incisor show at rest
  • Racial variance on incisor show
  • Changes with age on incisor show
  • What percent of lower facial heigh is occupied by upper lip?
  • Lower lip?
  • Ratio of Bizygomatic width to Bigonial width?
  • Chin throat angle?

  • 5mm Females>males
  • Whites show more than > Asians > Blacks
  • Decreases with age
  • Upper lip 30% lower facial height
  • Lower lip 25% lower facial height
  • Bigonial width 30% less than bizygomatic width
  • Chin throat angle 110


Steiner analysis

  • What assesses maxilla position? Normal range
  • Mandible position? Normal range
  • Max - Mand relationship? Normal range

  • What assesses maxilla position - SNA 79-84 deg
  • Mandible position - SNB 76-82 deg
  • Max - Mand relationship - ANB 4-0 deg


Ricketts Analysis

  • What assesses maxilla position?
  • Normal range

  • What assesses maxilla position? NA - FH
  • 86-94 deg


McNamara Analysis

  • What assesses maxilla position? Normal range

  • Mandible position? Normal range

  • Max - Mand relationship? Normal range

  • What assesses maxilla position? N perpendicular to A

    • Normal range 0-1mm

  • Mandible position? N perpendicular to Pog 

    • Normal range mixed dentition -7mm

    • Normal range female -4 to 0

    • Normal range male -2 to +2

  • Max - Mand relationship?

    • Midface length (Condylion to A) - mandible length (Condylion to Pog)

    • Normal range mixed dentition 19-21mm

    • Normal range female 25-27mm

    • Normal range male 30-33mm


Downs Analysis

  • Mandibular position reference points
  • Normal range
  • Similar to what analysis scheme for maxillary AP position

  • FH to N-Pog
  • 86-94 deg
  • Rickets uses FH to N-A point for maxilla


Steiner Facial Type Analysis

  • How to assess facial type with Steiner
  • Normal range

  • Intersection of Mandibular Plane with SN
  • 30-34 deg


Panorex findings of Long face

  1. Vertical growth, mandible rotated open, short ramus height, obtuse gonial angle


Panorex findings of Short face

Long ramus, acute gonial angle, horizontal growth, over-closed mandible, decreased lower facial height.