s10 - Congenital palatal defects

Question 1

What is the definition of maxillofacial prosthetics?

Answer 1

The branch of prosthodontics concerned with restoring/replacing missing or damaged oral and facial structures due to surgery, trauma, or congenital defects.

Question 2

What structures can maxillofacial prosthetics restore?

Answer 2

Teeth, oral tissues, and facial structures (e.g., ears, nose, eyes).

Question 3

What are the primary causes of maxillofacial defects?

Answer 3

Surgery, trauma, congenital malformations, or developmental defects.

Question 4

How does maxillofacial prosthetics differ from general prosthodontics?

Answer 4

It focuses on extra-oral and complex intra-oral rehabilitation (e.g., obturators, facial prostheses).

Question 5

What is the goal of maxillofacial prosthetic treatment?

Answer 5

To restore function (speech, swallowing), aesthetics, and psychosocial well-being.

Question 6

What are the three main types of maxillofacial defects?

Answer 6

Congenital, acquired, and developmental.

Question 7

Give two examples of congenital maxillofacial defects.

Answer 7

Cleft lip/palate, microtia (missing ear).

Question 8

What causes acquired maxillofacial defects?

Answer 8

Surgery (e.g., tumor resection), trauma, or pathology (e.g., osteoradionecrosis).

Question 9

Name two developmental maxillofacial defects.

Answer 9

Prognathism, retrognathism, macro/micrognathia.

Question 10

Why are congenital defects often more challenging to treat than acquired defects?

Answer 10

They involve growth abnormalities and may require multidisciplinary care from birth.

Question 11

How are maxillofacial prostheses classified by location?

Answer 11

Intra-oral, extra-oral, combined, or cranial/facial.

Question 12

What is the purpose of an intra-oral obturator?

Answer 12

To close a palatal defect (congenital or acquired) and improve speech/swallowing.

Question 13

Name three types of intra-oral stents and their uses.

Answer 13

Antihaemorrhagic (bleeding control), radium carriers (radiation therapy), mouth protectors.

Question 14

What is the function of a splint in maxillofacial prosthetics?

Answer 14

To stabilize jaw fractures by holding bone fragments in place during healing.

Question 15

When is a resection appliance used?

Answer 15

To correct mandibular closure paths after partial jaw resection.

Question 16

What are extra-oral prostheses? Examples?

Answer 16

Prostheses replacing facial structures (e.g., ocular, nasal, auricular prostheses).

Question 17

What is a radium shield prosthesis?

Answer 17

A protective device to shield tissues from radiation therapy.

Question 18

What are combined intra-oral/extra-oral prostheses used for?

Answer 18

Cases with loss of maxilla/mandible and adjacent facial structures.

Question 19

What is a cranial onlay/inlay prosthesis?

Answer 19

A prosthesis to replace lost cranial bone (e.g., after skull injury).

Question 20

What are intra-mandibular implants?

Answer 20

Implants placed within mandibular bone to support prostheses.

Question 21

Who are the key members of a maxillofacial rehabilitation team?

Answer 21

Plastic surgeon, prosthodontist, speech therapist, orthodontist, psychologist, social worker, dental technician.

Question 22

What is the role of the plastic surgeon in cleft care?

Answer 22

Surgical repair of lip/palate deformities and reconstructive procedures.

Question 23

When is a prosthodontist essential in maxillofacial cases?

Answer 23

When surgical reconstruction isn’t possible (e.g., large defects, unoperated clefts).

Question 24

How does a speech therapist contribute to cleft palate management?

Answer 24

Corrects compensatory speech patterns post-surgery/prosthetic placement.

Question 25

Why is an orthodontist involved in cleft care?

Answer 25

To manage malocclusion and align maxillary segments before/after surgery.

Question 26

What role does a psychologist play in treatment?

Answer 26

Helps patients cope with psychosocial challenges (e.g., self-esteem, social integration).

Question 27

How does a social worker support cleft patients/families?

Answer 27

Provides education, resources, and guidance on long-term care and community support.

Question 28

Define cleft lip and palate embryologically.

Answer 28

Failure of fusion between embryonic processes (premaxillary, lateral maxillary, palatine).

Question 29

What is the incidence rate of cleft lip/palate?

Answer 29

~1 in 800 live births.

Question 30

Which gender is more commonly affected by clefts?

Answer 30

Males (2:1 ratio).

Question 31

What does Veau Class I cleft involve?

Answer 31

Soft palate only.

Question 32

Describe Veau Class III cleft.

Answer 32

Unilateral cleft of hard/soft palate extending through alveolar ridge and lip.

Question 33

What is a bilateral complete cleft (Veau IV)?

Answer 33

Cleft affecting both sides of hard/soft palate, alveolus, and lip.

Question 34

How does a submucous cleft present clinically?

Answer 34

Intact mucosa with underlying muscle separation (often diagnosed late due to speech issues).

Question 35

What is the "prolabium" in bilateral cleft lip?

Answer 35

The central lip segment attached to the nasal septum.

Question 36

What is the primary function of the palato-pharyngeal sphincter?

Answer 36

To separate nasopharynx from oropharynx during speech/swallowing.

Question 37

Which muscle is most critical for velar elevation?

Answer 37

Levator veli palatini.

Question 38

What is the Ridge of Passavant?

Answer 38

A muscular bulge on the posterior pharyngeal wall aiding velopharyngeal closure.

Question 39

How does the relaxed position of the velum differ from its elevated position?

Answer 39

Relaxed: Velum hangs down (nasal breathing); Elevated: Curves upward (speech/swallowing).

Question 40

What compensates for inadequate velar length during closure?

Answer 40

Pharyngeal wall movement (medial/lateral) and Ridge of Passavant.

Question 41

Define palato-pharyngeal insufficiency (PPI).

Answer 41

Structural inadequacy (e.g., short palate) preventing closure.

Question 42

What causes palato-pharyngeal incompetence (PPI)?

Answer 42

Neuromuscular dysfunction (e.g., stroke, cerebral palsy) despite normal anatomy.

Question 43

How does PPI differ from PPI?

Answer 43

PPI: Anatomic defect; PPI: Functional impairment.

Question 44

What prosthetic device treats PPI?

Answer 44

Palatal lift prosthesis.

Question 45

Why is nasal breathing impossible with a meatal obturator?

Answer 45

It blocks the posterior nasal choanae.

Question 46

Name 3 hereditary factors linked to cleft formation.

Answer 46

Family history, genetic syndromes (e.g., Van der Woude), chromosomal abnormalities.

Question 47

How can maternal infections contribute to clefts?

Answer 47

Viruses like rubella disrupt embryonic process fusion during first trimester.

Question 48

Which vitamin deficiencies increase cleft risk?

Answer 48

Vitamin A, riboflavin (B2), and folic acid.

Question 49

What chemical exposures may cause clefts?

Answer 49

Teratogens (alcohol, phenytoin), hypoxia, hypervitaminosis A.

Question 50

How does radiation exposure lead to clefts?

Answer 50

Pelvic/therapeutic radiation in pregnancy damages developing facial processes.

Question 51

What hormonal factors influence cleft formation?

Answer 51

Cortisone therapy, maternal diabetes, thyroid disorders.

Question 52

Why is stress a risk factor?

Answer 52

High cortisol levels in 1st trimester may impair embryonic fusion.

Question 53

Why do cleft palate infants struggle with feeding?

Answer 53

Inability to generate negative pressure for sucking.

Question 54

How does food regurgitation occur in unrepaired clefts?

Answer 54

Nasopharynx remains open during swallowing.

Question 55

What masticatory problems arise from clefts?

Answer 55

Malocclusion, missing teeth, and alveolar defects.

Question 56

List 3 psychosocial impacts of clefts.

Answer 56

Low self-esteem, social stigma, depression/anxiety.

Question 57

What causes hypernasal speech in cleft patients?

Answer 57

Air escapes through nasal cavity due to inadequate palato-pharyngeal closure.

Question 58

Why is hearing loss common in cleft patients?

Answer 58

Eustachian tube dysfunction leads to chronic otitis media.

Question 59

Name the 7 steps of speech production.

Answer 59

Respiration → phonation → palato-pharyngeal closure → resonance → articulation → neurologic integration → audition.

Question 60

How do vocal cords modify speech?

Answer 60

Vibrate to produce laryngeal sound waves (phonation).

Question 61

Which sounds require nasal resonance?

Answer 61

/m/, /n/, /ŋ/ (e.g., "sing").

Question 62

What is the role of the tongue in articulation?

Answer 62

Shapes sounds by changing position (e.g., /t/, /d/, /l/).

Question 63

How does CNS damage affect speech?

Answer 63

Disrupts motor control of speech organs (dysarthria) or language processing (aphasia).

Question 64

Why is hearing critical for speech development?

Answer 64

Allows self-monitoring and sound imitation.

Question 65

What is the purpose of a feeding plate?

Answer 65

To seal the cleft during bottle-feeding in infants.

Question 66

Why are squeezable bottles used for cleft infants?

Answer 66

To compensate for inability to suck by gravity-assisted flow.

Question 67

When is lip repair typically performed?

Answer 67

6–12 weeks postpartum.

Question 68

Why delay hard palate closure until 12–18 months?

Answer 68

To allow maxillary growth and reduce scarring-induced midface hypoplasia.

Question 69

What is a pharyngeal flap surgery?

Answer 69

A tissue graft from pharynx to palate to improve closure.

Question 70

When is prosthetic treatment preferred over surgery?

Answer 70

In unoperated adults, failed surgeries, or poor surgical candidates.

Question 71

Describe a fixed pharyngeal obturator.

Answer 71

A prosthesis with palatal + pharyngeal sections to augment velopharyngeal closure.

Question 72

How is the pharyngeal bulb positioned clinically?

Answer 72

At the level of Passavant’s ridge during phonation ("ah").

Question 73

What is the advantage of a meatal obturator?

Answer 73

Reduces leverage compared to horizontal pharyngeal extensions.

Question 74

Why might a palatal lift prosthesis fail?

Answer 74

If the patient has inadequate neuromuscular control.

Question 75

What is the key difference between speech aid and feeding appliances?

Answer 75

Speech aids target velopharyngeal closure; feeding appliances focus on nutrition.