Quiz 2 - Trump - Embryology Of Head, Face, And Oral Cavity

Question 1

When does central face development begin?

Answer 1

Week 4

Question 2

Where does central face development happen?

Answer 2

Nasal placodes

-Placodes = thickening

Question 3

Upper lip formation, when?

Answer 3

Weeks 6-7

Question 4

Upper lip formation, where?

Answer 4

Medial nasal processes merge w/ each other as well as the maxillary processes of the first branchial arches

Question 5

The primary palate is made from what?

Answer 5

Merger of the medial nasal process

Question 6

The secondary palate is formed from what?

Answer 6

Formed from the maxillary processes of the first branchial arches

Question 7

What is the primary palate? What is the secondary palate?

Answer 7

Primary - Right around the central incisors

Secondary - The rest of the hard palate (90% of it)

Question 8

Two types are conditions, what are they?

Answer 8

Developmental

Hereditary/Genetic

• Familial
• Congenital

Question 9

Cleft lip is what?

Answer 9

Defective fusion of the medial nasal process with the maxillary process

80% of cases are unilateral

Question 10

Treatment for cleft lip?

Answer 10

Rule of 10

• 10 weeks
• 10 lbs
• 10 gm %Hemoglobin

Question 11

What happens with cleft palate?

Answer 11

Failure of the palatal shelves to fuse

-Minimal manifestation of cleft palate is bifid uvula

Question 12

What about treatment for cleft palate?

Answer 12

Start only after 1.5 yrs of life

• 45% of cases are cleft lip and cleft palate
• 30% are only cleft palate
• 25% are cleft lip

Question 13

Some clefting is due to what?

Answer 13

Syndromic

Question 14

With syndromic clefting, ____% of pts have cleft palate only.

Answer 14

50%

• Most cases in syndromic clefting are cleft palate only
• Most cases in overall clefting are both cleft lip and cleft palate

Question 15

Tell me about clefting with Pierre Robin.

Answer 15

Cleft palate only

Mandibular micrognathia - small mandible

Glossoptosis - Downward displacement of tongue

Question 16

Clefting can also occur in a non-syndromic way. Name some environmental factors.

Answer 16

Maternal alcohol or cigarette use

Folic acid deficiency

Corticosteroid use

Anticonvulsant therapy

Question 17

A lateral facial cleft happens when?

Answer 17

Lack of fusion of the maxillary and mandibular processes

-Very rare

Question 18

An oblique facial cleft happens when?

Answer 18

Failure of fusion of the lateral nasal processes with maxillary process

• Upper lip to the eye
• ALMOST ALWAYS ASSOCIATED WITH CLEFT PALATE

Question 19

When does median clefting happen?

Answer 19

Failure of fusion of the medial nasal processes

-Very rare

Question 20

T/F - One of the most common major congenital defects.

Answer 20

TRUE

Question 21

Prevalence of clefting?

Native Americans

Asians

Whites

Blacks

Answer 21

1 in 250

1 in 300

1 in 700

1 in 1500

Question 22

T/F - Cleft lip and cleft palate is more common in males.

Answer 22

TRUE

Question 23

T/F - Cleft palate only is more common in females

Answer 23

TRUE

Question 24

What is a submucous palatal cleft?

Answer 24

Surface is intact, but defect exists in the underlying musculature of the soft palate

-Bone notch will be present on post hard palate and appears as a bluish midline discoloration

Question 25

What are lip pits?

Answer 25

Occur in commissures - Mucosal invaginations that occur at the corners of the mouth on the vermilion border - NOT CLEFTING, but an issue with deposition of collagen

Question 26

What are paramedical lip pits?

Answer 26

Congenital invagination of the lower lip -Usually bilateral

Question 27

What syndrome is associated with lip pits?

Answer 27

Van der Woude Syndrome - Greatest significance of paramedian lip pits - With cleft lip and cleft palate

Question 28

What is microglossia?

Answer 28

Abnormally small tongue - Usually syndromic - Rarely, the entire tongue may be missing (Aglossia) - Associated with hypoplasia of the mandible (micrognathia) - Lower incisors may be missing - Tx depends on nature and severity of condition

Question 29

What is ankyloglossia?

Answer 29

Developmental tongue abnormality characterized by a short, thick lingual frenum, which limits tongue movement * This is called tongue-tied* - 4% of neonates - May cause problems with speech and breastfeeding - No tx req’d if asymptomatic, or may be self-correcting - Frenotomy or frenuloplasty - wait until age 4-5

Question 30

Where does the thyroid gland begin?

Answer 30

Foramen cecum - Begins as an epithelial proliferation in the floor of the pharyngeal gut during week 3-4 of embryogenesis During week 7, the thyroid bud normally descends into the neck, ant to trachea and larynx

Question 31

Site where the descending bud invaginates later becomes the?

Answer 31

Foramen cecum -Located at junction of ant 2/3 and post 1/3 of the tongue in midline

Question 32

If primitive gland doesn’t descend normally, then ectopic thyroid can be found b/t what?

Answer 32

Foramen cecum and the epiglottis -90% of ectopic thyroids (also called lingual thyroids) are found here

Question 33

T/F - Lingual thyroid is 7x more common in females.

Answer 33

TRUE

Question 34

What are some symptoms with lingual thyroid?

Answer 34

Arise during puberty, adolescence, pregnancy, or menopause | -Dysphagia, dysphasia, dyspnea

Question 35

T/F - 1/3 of lingual thyroid pts have hypothyroidism.

Answer 35

TRUE

Question 36

How to diagnose lingual thyroid?

Answer 36

Via thyroid scan using iodine isotopes or technetium-99m), CT, and/or MRI -Biopies are avoided

Question 37

What is a thyroglossal duct cyst?

Answer 37

Develop from epithelial remnants of the thyroglossal tract - 50% are diagnosed before age 20 - Painless, fluctuating, movable swelling at or near midline, usually inferior to the hyoid bone - Tx - surgical removal - 10% recurrence - 1% carcinoma

Question 38

What is hemihyperplasia?

Answer 38

Rare developmental anomaly Asymmetric growth of one of more body parts (unilateral macroglossia) **Hyperplasia - Increase in cell NUMBER

Question 39

What is craniosynostosis?

Answer 39

Premature closing of the cranial sutures - Brachycephaly (short head), scaphocephaly (boat-shaped head), trigonocephaly (triangle head) - Cloverleaf skull (KLEEBLATT-SCHADEL deformity) - Underdeveloped maxilla - Skull X-ray shows beaten-metal pattern

Question 40

What is apert syndrome (acrocephalosyndactyly)?

Answer 40

Ocular proptosis - Eyes sticking out Hypertelorism Downward slant of lateral palpebral fissures Webbing of 2nd, 3rd, and 4th digits of hands and feet Mental retardation 75% have cleft soft palate or bifid uvula

Question 41

Treacher-Collins Syndrome?

Answer 41

Defects of structures derived from 1st and 2nd branchial arches Hypoplastic zygoma, coloboma (notch on outer portion of lower eyelid), underdeveloped mandible

Question 42

What is Stafne defect?

Answer 42

AKA Lingual mandibular salivary gland depression Focal concavity of the cortical bone in the lingual surface of the mandible **Classically presents as an asymmptomatic, well-circumscribed radiolucency below the mandibular canal in the posterior mandible b/t the molar teeth and the angle of the mandible -No treatment