CLEFT LIP AND PALATE mc facial cleft Ethnic grp w/ the highest incidence of cleft lip Ethnic grp

w/ the highest incidence of isoated cleft palate M:F for cleft lip, w/ or w/o cleft palate M:F for isolated cleft palate Incidence of isolated cleft palate among term NB If one parent is affected, what is the chance of having a cleft lip child? Mc single gene transmission error causing clefts Mc environmental cause of clefts Divides the palate into primary & secondary palate What artery runs through the incisive foramen What structure forms the hard palate What muscles form the soft palate

Cleft uvula Native americans Equal incidence among racial groups 2:1 1:2 1:2000 4% Trisomy 21 Poorly controlled maternal diabetes Amniotic band syndrome Incisive foramen Lesser palatine artery M-axilla P-terygoid plates H-ard process of the palatine bone Palatoglossus Palatopharyngeus Salpingopharyngeus Superior constrictor muscles Levator and tensor veli palatini Muscular uvula At the peaks of the cupids bow 4-5 wks AOG As a mesodermal and ectodermal proliferation of the frontonasal and maxillary processes 8-9 wks AOG as a medial ingrowth of the lateral maxillae with fusion in the midline Lack of mesodermal proliferation result in an incomplete epithelial bridge True False: but a cleft alveolus is always associated with a cleft lip Inferior and posterior displacement of the alar cartilage on the cleft side Muscle fibers remain continous but are hypoplastic across the cleft Bridge of tissue connecting the central and lateral lip in an incomplete cleft lip A varying amount of mucosal

widest point of the vermillion border When does primary palate develop How? When does secondary palate develop How? during embryologic development, what causes a cleft lip At no time in the development of the normal primary palate is there a separation A cleft lip is always associated with a cleft alveolus What is the characteristic nasal deformity of a child with a unilateral cleft lip What happens to the orbicularis oris muscle in a complete cleft lip Simonarts band What is an incomplete cleft?

What type of cleft is a submucous cleft palate? What happens to the soft palate muscles in a secondary CP? Boundaries of a unilateral cleft of the primary palate Difference b/w complete cleft of the primary and secondary palate

attachment is preserved with an underlying muscular deficiency Incomplete cleft of the secondary palate Muscle fibers follow the cleft margins and insert into the posterior edge of the remaining soft palate From the incisive foramen anteriorly, b/w the canine and adjacent incisor to the lip Complete cleft of the primary palate - Extends into the nose - Is always assoc with a cleft lip - Does not expose the vomer Complete cleft of the secondary palate - Extends into the nose - Involves both hard & soft palate - Exposes the vomer Veau and iowa classifications Secondary palate clefts (either isolated or
in combination with CL & cleft of primary palate)

2 most commonly used classification systems for clefts Feeding difficulty is sever in which type? Strategies used to assist feeding a px with cleft palate % of children who does not require tympanostomy tubes What further facial deformities often occur as a child with a cleft palate grows? Role of palatal plates in the tx of cleft palates

Specialized nipples Upright feeding to minimize nasal regurgitation Palatal plates 8-10% Collapse of the alveolar arch Midface retrusion Malocclusion Palatal plates when worn 3 mos prior to surgery and adjusted weekly to bring the palate and the alveolus into a more normal shape, has been shown to lessen closure tension during surgery Straight line closure A preliminary step in cleft lip repair where a complete CL is converted into an incomplete cleft To facilitate definitive repair by decreasing the tension across the wound 2-4 week of age Creates scar tissue that can interfere with definitive repair Alignment of the vermillion border (rule of 10) 10 weeks old; 10 lbs; hgb 10 Delayed 4 months if lip adhesion is performed

First approach described for cleft lip repair What is lip adhesion? Purpose of lip adhesion When is lip adhesion performed? Primary disadvantage of lip adhesion Most impt factor in the aesthetic outcome of lip reconstruction When is a cleft lip normally repaired

When is cleft palate repair performed? What is the significance of the timing of palatal repair on midfacial growth and speech?

>6 months Earlier repair is assoc. w/ better speech but midface retrusion; Later repair is assoc w/ worse speech but minimal face retrusion. More evidence exists to support the importance of timing on speech than on midface retrusion Consonants, as they need full palatal lift Superior constrictor muscle Up to 20% 4 y/o Intractable VPI not responsive to speech therapy b/w 9 to 11 y/o GH deficiency, as it is 40x more common in this population In teenage years when growth spurt occurs Rhinoplasty Straight line repair Tennison triagular flap repair Millard rotation advancement flap A medial rotation flap to align the vermillion A triangular C flap to lengthen the columella An advancement flap to close the upper lip & nostril sill. Medial segment is rotated inferiorly Lateral segment is then advanced medially Preserves cupids bow & philtral dimple By placing the tension of closure under the alar base, it reduces flare & promotes improved molding of the underlying alveolar process Two flap palatoplasty, by: Bardach & Slayer Intavelar palatoplasty V-Y advancement Double reversing Z-plasty V-Y advancement

What sounds are more difficult for pxs w/ CP? What muscle is primarily responsible for preventing velopharyngeal insufficiency? What % of pxs eventually require pharyngoplasty to reduce VPI? What age is pharyngoplasty typically done? Indications for pharyngoplasty after CP repair When is alveolar bone grafting typically done? What should be suspected in children w/ CP who fall below the 5th percentile of growth? When does midface retrusion present in children w/ CP? midface retrusion treated by 3 techniques most often used for unilateral cleft lip repair Key features of the Millard CL repair

In millard repair, which part of the lip is rotated? Advanced? Advantages of millard repair

mc repair for complete unilateral CP What is the term for repair of the levator veli palatini ms during CP repair? 2 mc methods of secondary CP repair Best for clefts extending into the hard palate

For w/c type of cleft is the Double reversing Z-plasty best?