Cleft Lip and Palate Overview
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Questions and Answers

When should surgical correction of nasal deformities typically be performed?

  • Immediately after the birth of the child
  • During the first year of life regardless of other issues
  • Once all clefts and associated problems have been corrected (correct)
  • Only after speech therapy has been completed

What is a common feeding solution for infants with a cleft palate?

  • Solid foods blended into a smooth paste
  • Standard baby bottles with regular nipples
  • Specially designed elongated bottles (correct)
  • Feeding tubes inserted directly into the stomach

What condition are children with a cleft of the soft palate particularly predisposed to?

  • Middle ear infections (correct)
  • Skin allergies
  • Respiratory infections
  • Gastrointestinal problems

What is the primary purpose of the naso-alveolar molding device?

<p>To seal the gap in the palate for better feeding (B)</p> Signup and view all the answers

What commonly occurs due to the inability of the velopharyngeal mechanism to function properly in individuals with a cleft palate?

<p>Hypernasal speech (C)</p> Signup and view all the answers

What is the recommended age for performing lip closure in an otherwise healthy baby?

<p>3 months with lip taping (C)</p> Signup and view all the answers

What is the most common speech issue associated with cleft lip and palate deformities?

<p>Retardation of consonant sounds (D)</p> Signup and view all the answers

Which technique is best suited for repairing cleft palate while addressing speech issues?

<p>Furlow’s Z-plasty (A)</p> Signup and view all the answers

What disadvantage is associated with the Rotation-Advancement technique in unilateral cleft lip repair?

<p>Notch in the vermillion border (B)</p> Signup and view all the answers

What is a potential consequence of improper seal during feeding in infants with cleft palates?

<p>Recurrent chest infections (C)</p> Signup and view all the answers

What is typically the timing for palatal repair in infants?

<p>9-18 months (A)</p> Signup and view all the answers

Which of the following criteria is NOT part of the 'rule of 10' for determining surgical readiness?

<p>Age of 10 months (B)</p> Signup and view all the answers

What surgical procedure might be necessary for children with cleft palate to manage their middle ear health?

<p>Myringotomy (D)</p> Signup and view all the answers

In bilateral cleft lip repair according to Millard’s concept, how is the measurement for the philtrum length determined?

<p>Philtrum +2mm (A)</p> Signup and view all the answers

Which surgical technique repairs only the hard palate?

<p>von Langenbeck operation (C)</p> Signup and view all the answers

What is the role of the Dingman retractor in cleft palate repair?

<p>To enhance visibility during the procedure (A)</p> Signup and view all the answers

What percentage of clefts are classified as unilateral deformities?

<p>75% (B)</p> Signup and view all the answers

Which of the following is NOT a common dental problem associated with clefts?

<p>Altered tooth color (D)</p> Signup and view all the answers

What is the main contributing factor to malocclusion in individuals with cleft deformities?

<p>Retardation of maxillary growth (B)</p> Signup and view all the answers

Which feature is associated with a cleft lip?

<p>Deviation of the nasal columella (B)</p> Signup and view all the answers

Which of the following describes a microform cleft?

<p>An intact functional layer (C)</p> Signup and view all the answers

What anatomical region is most commonly affected by a cleft?

<p>The alveolar ridge (A)</p> Signup and view all the answers

What is the significance of the cleft extending between the lateral incisor and the canine area?

<p>It increases the likelihood of dental issues. (A)</p> Signup and view all the answers

Which type of cleft is less common?

<p>Bilateral cleft lip (B)</p> Signup and view all the answers

What is one of the primary reasons for performing an Alveolar Cleft Graft (ACG)?

<p>Eliminating oro-nasal fistulae (C)</p> Signup and view all the answers

At what age is secondary bone grafting typically performed?

<p>During the mixed stage of dentition (6-12 years) (A)</p> Signup and view all the answers

What is a merit of Alveolar Cleft Grafting?

<p>Supports eruption of permanent teeth (C)</p> Signup and view all the answers

Which of the following is a common disadvantage associated with ACG?

<p>Requires comprehensive orthodontic and surgical care (D)</p> Signup and view all the answers

Which type of graft is obtained from intraoral sources for ACG?

<p>Symphyseal grafts (C)</p> Signup and view all the answers

What condition might a patient with a cleft palate experience concerning their jaw alignment?

<p>Class III (mandibular prognathism) (B)</p> Signup and view all the answers

What is a sign of success for bone grafting in cleft palate patients?

<p>Interdental bone formation confirmed by periapical radiograph (C)</p> Signup and view all the answers

What is essential to do before the age of 6-12 years in preparation for bone grafting?

<p>Implement maxillary expansion (B)</p> Signup and view all the answers

Flashcards

Rule of 10 for surgery

A set of guidelines for determining if a baby is healthy enough for surgery, including weight (10 pounds), hemoglobin (10 gm/dl), leukocyte count (10,000), and age (10 weeks).

Naso-alveolar Molding Device

A device used to reshape the lip, gum, and nose before surgery in cases of cleft lip and palate. It helps reduce the deformity and facilitates feeding.

Triangular Flap Technique

Surgical technique where a triangular flap of tissue is used to repair the lip, providing a more natural appearance.

Z-Plasty for Cleft Lip

A surgical technique for repairing a cleft lip that involves a flap of tissue shaped like a 'Z', used to lengthen and reshape the lip.

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Von Langenbeck Operation

A surgical technique for repairing a cleft palate that involves closing both the hard and soft palate, using a double-layer approach, often resulting in better speech.

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Furlow's Z-Plasty

A surgical technique aimed at improving the speech and palate function in cleft palate repair by lengthening the palate using a 'Z' shape.

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Buccal Musculo-mucosal Flap

A flap of tissue taken from the cheek lining to close the gap in the palate during cleft palate repair.

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Dingman Retractor

A specialized surgical instrument used during cleft palate surgeries to retract the cheeks, tongue, and other tissues, providing a clear view of the surgical area.

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Flattening of the alar base

The nasal base is flattened, making the nose appear wider and less defined. This is a common characteristic in individuals with cleft lip and palate.

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Timing of nasal surgery for cleft

Surgical correction of nasal deformities in individuals with cleft lip and palate is typically delayed until other associated problems, such as the cleft itself, are addressed.

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Feeding difficulties in cleft palate

The muscles in the mouth and palate are underdeveloped or misaligned, leading to difficulties creating a good seal for sucking, making it challenging for the baby to feed.

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Ear problems in cleft palate

Individuals with cleft palate are prone to middle ear infections due to a lack of proper function in the muscles that control the Eustachian tube.

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Speech difficulties in cleft palate

The lack of a continuous soft palate prevents proper closure of the nasal passage during speech, resulting in a hypernasal voice.

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Timing of lip repair

Surgery to repair a cleft lip is typically performed between 3 and 6 months of age, focusing on repairing the orbicularis oris muscle, which controls the lips.

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Timing of palate repair

Surgery to repair a cleft palate is usually performed between 9 and 18 months of age, aiming to close the gap in the roof of the mouth.

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Recurrent chest infections in cleft palate

During feeding, milk can enter the nose and potentially the lungs due to poor oral seal, leading to recurrent chest infections.

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Alveolar Cleft Grafting (ACG)

A procedure where bone is grafted onto the alveolar cleft to close the gap and provide support for the missing bone. This helps restore the shape of the upper jaw and allows for proper tooth development.

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Rationale for ACG

The reason for performing an alveolar cleft grafting procedure. These include restoring the upper jaw's shape, closing openings between the mouth and nose, providing support for teeth, and improving the overall structure of the face.

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Timing for ACG

The timing for performing an alveolar cleft grafting procedure. This can be done before the permanent teeth erupt, during the mixed dentition stage when both baby and adult teeth are present, or after all permanent teeth have erupted.

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ACG Donor Sites

The process of obtaining bone for grafting. It can be taken from either outside the mouth, like the hip bone, or inside, like the chin.

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ACG Merits

The advantages of an alveolar cleft grafting procedure. This includes restoring the proper shape of the upper jaw, supporting the eruption of permanent teeth, and providing a stable environment for the face.

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ACG Demerits

The disadvantages of an alveolar cleft grafting procedure. This includes potential problems with the soft tissues in the area, the need for coordinated orthodontic care, and the need to carefully monitor the face's growth.

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Maxillary Collapse

The collapse of the upper jaw due to scar tissue contraction that can happen in patients with cleft palates.

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Maxillary Expansion

The process of widening the upper jaw before bone grafting to create a larger space for the graft to fill. This procedure is often done in patients with cleft palates.

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What is a cleft?

A congenital condition where there is a gap in the upper lip, alveolus, or palate.

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What are the goals of cleft treatment?

The treatment for cleft lip and palate aims to address issues with appearance, speech, hearing, chewing, and swallowing.

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How often are clefts unilateral or bilateral?

Most clefts occur on only one side of the face (unilateral), while a smaller percentage occur on both sides (bilateral).

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What are the types of cleft presentation?

The cleft can be either completely or partially present (incomplete), impacting the full or partial structure of the lip, alveolus, or palate.

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What is a 'microform' cleft?

A mild form of cleft where the outer layer of the lip is intact, but there's a gap in the underlying tissue.

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What are the dental problems associated with clefts?

The absence or presence of extra teeth can occur due to the developmental disruption caused by the cleft.

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What is malocclusion in individuals with clefts?

Individuals with clefts may experience problems with the alignment of their upper and lower jaws (malocclusion).

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Why does malocclusion occur in individuals with clefts?

Restricted growth of the upper jaw (maxilla) and scarring from cleft repair can contribute to malocclusion.

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Study Notes

Cleft Lip and Palate

  • A cleft is a congenital opening or gap in the upper lip, alveolus, or palate.
  • Cleft deformities affect appearance, speech, hearing, chewing and swallowing.
  • Unilateral clefts (one side) are more common than bilateral (both sides). Left side clefts are more frequent than right side clefts if unilateral.
  • A cleft lip can occur without a palate cleft, and vice versa.

Anatomy of the Velum

  • The velum comprises several muscles, including the levator veli palatini, tensor veli palatini, palatopharyngeus, musculus uvulae, and palatoglossus.
  • The illustrations show the location and interrelation of these muscles.
  • These anatomical structures are crucial for proper swallowing and speech.

Problems of Individuals with Clefts

Dental Problems

  • Cleft alveolus often affects primary and permanent tooth development.
  • Congenital absence or extra teeth are common problems.
  • Missing or extra teeth in the lateral incisor to canine area is frequently seen.
  • Bilateral clefts are more likely to cause these problems due to the cleft's proximity to these teeth.

Malocclusion

  • Skeletal inconsistencies in jaw size, shape, and position are common in cleft patients.
  • Missing or extra teeth contribute to malocclusion.
  • Maxillary growth retardation is a major cause of malocclusion.
  • Scarring from cleft repair negatively affects maxillary growth.

Lip and Nasal Deformity

  • Cleft lips commonly exhibit notches, deviation of the nasal columella, flaring of nasal alae and flattening of the alar base.
  • Surgical correction of nasal deformities is often deferred until comprehensive repair is complete.

Feeding

  • Feeding difficulties often result from underdeveloped or misaligned muscles.
  • Specially designed bottles are often recommended.

Ear Problems

  • Middle ear infections are frequent in children with cleft soft palate.
  • The levator veli palatini and tensor veli palatini muscles, which are normally attached to the opposite sides, are often misaligned in cleft palates.
  • These muscles control the Eustachian tube's opening, affecting middle ear pressure regulation and fluid drainage.
  • These problems often lead to serous otitis media (fluid buildup in the middle ear).

Surgical Management Hints

  • Surgical approaches vary based on the patient's specific needs, and are tailored to the location, degree, and type of the cleft defects.

Timing of Surgical Repair

  • Lip repair is typically performed between 3 and 6 months of age.
  • Palate repair is usually performed between 9 and 18 months of age.

Cleft Palate Repair

  • Various techniques like von Langenbeck, Furlow's Z-plasty, and buccal mucosal flaps are used for cleft palate repair.
  • These techniques, often requiring multiple stages, aim to maximize palate function and speech clarity.

Grafting the Alveolar Cleft

  • Reasons for grafting include improving nasal and oral anatomy, stabilizing the maxilla, and providing bony support for teeth.
  • Bone grafting timelines include before, during or after deciduous or adult dentition.
  • Various donor sites and materials (autogenous, allogeneic) are used for bone grafting.

Referral Centers

  • Multidisciplinary care, including speech therapy, orthodontia and surgical intervention, are essential for cleft patients.
  • Timing of treatment varies based on the type of intervention.
  • The goal is to achieve ideal facial and oral functioning.

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Related Documents

Cleft Lip And Palate PDF

Description

This quiz explores the fundamentals of cleft lip and palate, including their definition, common types, and associated anatomical structures. Gain insights into the challenges faced by individuals with these conditions, focusing on speech, swallowing, and dental issues. Discover the critical roles played by the velum muscles in effective communication and nutrition.

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