Cleft Lip and Palate Overview
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Questions and Answers

What is the occurrence rate of cleft lip with or without cleft palate in live births?

  • 1 in 600 (correct)
  • 1 in 2000
  • 1 in 1500
  • 1 in 1000

    • Which statement describes a complete cleft lip?

  • It extends across the whole lip and into the nostrils. (correct)
  • It is always unilateral.
  • It can only be unilateral.
  • It does not extend into the nostrils.

    • What is the primary structure responsible for the formation of the upper lip during embryonic development?

  • Bilateral mandible
  • Frontonasal prominence (correct)
  • Bilateral maxillary prominences (correct)
  • Lateral palatal processes

    • At what gestational weeks does the critical period for lip and palate development occur?

    <p>Weeks 6 to 9</p> Signup and view all the answers

    What type of cleft occurs when the palate fissure extends beyond the incisive foramen?

    <p>Complete cleft palate</p> Signup and view all the answers

    What results from the incomplete fusion of the two palatal shelves?

    <p>Cleft palate</p> Signup and view all the answers

    Which embryonic structures give rise to the secondary palate?

    <p>Lateral palatal processes</p> Signup and view all the answers

    What is the primary defect leading to the occurrence of cleft lip?

    <p>Incomplete fusion between frontonasal prominence and maxillary processes</p> Signup and view all the answers

    What should be avoided in infants with cleft palates due to the risk of airway obstruction?

    <p>Sedative premedication</p> Signup and view all the answers

    Which inhalational anesthetics are considered safe for induction of anesthesia?

    <p>Halothane and sevoflurane</p> Signup and view all the answers

    Which technique is NOT recommended for managing difficult endotracheal intubation in children with craniofacial syndrome?

    <p>Standard oral intubation</p> Signup and view all the answers

    What should be confirmed before administering neuromuscular blocking agents?

    <p>Ability to ventilate the lungs with a mask</p> Signup and view all the answers

    What is the purpose of using an oral pack in the surgical setting?

    <p>To absorb blood and secretions</p> Signup and view all the answers

    What key factor must be managed during anesthesia maintenance?

    <p>Controlling temperature</p> Signup and view all the answers

    What should be performed after positioning the patient for surgery?

    <p>Checking the patency and position of the endotracheal tube</p> Signup and view all the answers

    What can common problems with the endotracheal tube lead to?

    <p>Extubation or endobronchial intubation</p> Signup and view all the answers

    Which condition is NOT commonly associated with airway obstruction in patients with congenital abnormalities?

    <p>Cleft Lip</p> Signup and view all the answers

    What is the main anesthetic concern related to intubation in infants under 6 months of age?

    <p>Difficult intubation due to retrognathia</p> Signup and view all the answers

    Which of the following is NOT a common preoperative evaluation for a patient with cleft palate?

    <p>Evaluation of speech therapy needs</p> Signup and view all the answers

    What percentage of patients with congenital abnormalities might experience congenital heart disease?

    <p>5 - 10%</p> Signup and view all the answers

    Which statement about obstructive sleep apnea syndrome in the context of anesthesia is true?

    <p>Patients are sensitive to respiratory depressant effects of anesthetics.</p> Signup and view all the answers

    Chronic rhinorrhea in children presenting for cleft palate closure is primarily caused by what?

    <p>Reflux into the nose during feeds</p> Signup and view all the answers

    What complication may arise from recurrent hypoxia due to airway obstruction?

    <p>Right ventricular hypertrophy</p> Signup and view all the answers

    What is a potential nutritional concern for patients with cleft palate?

    <p>Nutritional anemia due to feeding difficulties</p> Signup and view all the answers

    What is a spontaneous breathing technique with halothane used for?

    <p>To provide safety during accidental disconnection or extubation.</p> Signup and view all the answers

    Which of the following is NOT a benefit of controlled ventilation with muscle paralysis?

    <p>Increased PaCO2 levels.</p> Signup and view all the answers

    What is the role of adrenaline in local infiltrations?

    <p>To prolong the effects of local anesthetics.</p> Signup and view all the answers

    Which opioid is noted for helping achieve smoother emergence during extubation?

    <p>Fentanyl.</p> Signup and view all the answers

    What is the anatomical location of the infraorbital nerve?

    <p>Just medial to the infraorbital foramen.</p> Signup and view all the answers

    What is the procedure for blocking the infraorbital nerve?

    <p>Insert the needle perpendicularly to the skin until bony resistance is felt.</p> Signup and view all the answers

    What is a significant risk following extubation?

    <p>Acute airway obstruction.</p> Signup and view all the answers

    How much adrenaline should be administered with local infiltrations in the presence of normocapnia and halothane?

    <p>5 mcg/kg.</p> Signup and view all the answers

    Study Notes

    Introduction

    • Cleft lip and palate are the most common craniofacial abnormalities
    • Cleft lip (with or without cleft palate) occurs in 1/600 live births
    • Cleft palate alone occurs in 1/2000 live births
    • Cleft can involve lip, alveolus (gum), hard palate, soft palate (or a combination)
    • Can be complete or incomplete
    • Can be unilateral or bilateral

    Anatomy

    • Cleft lip (CL): Unilateral or bilateral fissure in the upper lip

    • Complete CL: Extends across the entire lip and into the nostrils

    • Incomplete CL: Ranges from subtle indentations to large defects with little tissue between clefts

    • Cleft palate (CP): Unilateral or bilateral fissure in the soft palate, may extend to the hard palate

    • Cleft palate can co-occur with cleft lip when the lip fissure extends past the incisive foramen, including the palatine suture

    Embryology

    • Lip and palate development occurs in the first trimester (weeks 6-9 of gestation)
    • Upper lip and primary palate form from fusion of frontonasal and bilateral maxillary prominences
    • Cleft lip occurs when this fusion fails on one or both sides

    Clinical Problems

    • Facial disfigurement and potential social isolation
    • Feeding problems and abnormal speech

    Anesthetic Concerns

    • Majority of anesthetic morbidity related to cleft lip/palate surgery is airway related
    • Difficulty with intubation
    • Inadvertent extubation during procedure
    • Postoperative airway obstruction
    • Optimal anesthetic management depends on patient age, equipment, anesthetic drugs, and expertise

    Preoperative Evaluation

    • Thorough history and physical exam
    • Identify associated congenital abnormalities (e.g., Pierre-Robin sequence, Goldenhar syndrome, Treacher Collins syndrome)
    • Assess for congenital heart disease (occurs in 5-10% of cleft patients)
    • Assess for chronic rhinorrhea (common due to reflux during feeding)
    • Evaluate for obstructive sleep apnea syndrome (patients are highly sensitive to respiratory depressants in anesthetics)

    Extubation

    • Acute airway obstruction is a significant risk
    • Surgeon should ensure the surgical field is dry
    • Minimize suctioning to prevent surgical repair disruption
    • Oropharyngeal airways should be avoided, if possible
    • Tongue stitch may be placed in patients with pre-op airway obstruction to pull tongue away from the posterior pharyngeal wall for post-op airway support

    Key Points

    • Difficult laryngoscopy is a more frequent finding than a difficult airway
    • Patients should be extubated when fully awake, closely monitored for airway obstruction
    • Analgesia is an important part of balanced anesthetic technique

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    Related Documents

    Anaesthesia for Cleft Lip and Palate Surgery PDF

    Description

    Explore the fundamental aspects of cleft lip and palate, the most common craniofacial abnormalities. This quiz covers their anatomy, occurrence rates, and embryological development. Test your knowledge on the characteristics and classifications of these conditions.

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