Ch. 18 Clefts Surgical Management

Front 1

Regardless of degree of cleft involved surgical principals remain the same. With lip and palate clefts other aesthetic areas are affected besides lip and roof of mouth. NAme them

Back 1

nose midface,
ANATOMICAL= jaw, teeth, oral sphincter, VELOPHARYNGEAL sphinter
FUNCTIONAL= AIRWAY, HEARING, SPEECH, FEEDING
PSYCHOLOGICALLY= individuals identity

Front 2

What is another surgical term for LIP REPAIR?

Back 2

CHEILOPLASTY

Front 3

What is the rule of 10 ?

Back 3

10 weeks of age, 10 lbs, 10 hemoglobin gms

Front 4

Presurgical mangment with a unilateral CLEFT LIP:
Name from simplest,active appliance and surgical.

Back 4

Simplest: Tape/dental elastics
Latham Appliance= Active dental appliance- pinned to greater and lesser palate
Surgical= Lip adhesion (initial: 6wks of age)
Formal lip repair= 3-4 months old

Front 5

Name the technique used in 80% of cases, most anatomical, "cut as you go" , adjustments are constantly made during procedure for lip balance

Back 5

MILLARD TECHNIQUE/ Rotation Advancement FLAP

Front 6

TECHNIQUE FOR PALATOPLASTY where is the incision made?

Back 6

gum line, behind teeth, extending up from area of canine tooth, incision on gum line usually left open

Front 7

DOES A CLEFT PALATE ALSO change the velopharyngeal sphincter?

Back 7

YES IT DOES , patient with cleft palate LEVATOR VELI PALATINI inserts into back of hard palate instead of fusing in midline of velum to form levator sling.

Front 8

2 philosphies of cleft palate repair

Back 8

EARLY= 6 mo-15 months
LATE= 15 months-24 months

EARLIER palate repair= lower incidence of velopharyngeal insufficiency, and development of compensatory articulation problems

Front 9

FISTULA REPAIR TECHNIQUES: AN INTENTIONAL FISTULA RESULTS IN?

Back 9

LESS RESTRICTION OF ANTERIOR FACIAL GROWTH. FISTULA IS CLOSED EARLY TO MID MIXED DENTITION W/ BONE GRAFT FROM RIB OR ILLIAC CREST.

Front 10

WITH FISTULA Repair techniques what can help complete the dental arch and allow an eruption of permanent dentition.

Back 10

Intentional fistula, closed in early to mid mixed dentition w/ bone graft from RIB or illiac crest

Front 11

Closure of fistulas attempted with use of?

Back 11

Local autogenous tissue first., (is not adequate local tissue , or failed closure attempt, more complex procedure necessary

Front 12

Techniques for Fistula repair include?

Back 12

TURBINATES: flaps of tissue, buccal surface based on facial artery & tongue flap

Front 13

With tongue flap procedure this is done for what type of repair and what is it?

Back 13

Fistula repair, Dorsum of tongue sutured INTO fistula= 2-3 weeks to develop blood supply

Front 14

How many weeks with the tongue flap technique used in fistula repair will blood supply develop?

Back 14

2-3 weeks

Front 15

Why may there be Velopharyngeal insufficiency?

Back 15

Due to scarring from initial palatoplasty.

Front 16

Is surgery for velopharyngeal insufficiency done with babies?

Back 16

NO NOT DONE WITH BABIES

Front 17

VPI diagnosis cannot be made until child begins to introduce what type of speech?

Back 17

Connected speech: typically age of 3yrs old

Front 18

HOW DO YOU EVALUATE for a VPI?

Back 18

nasopharygoscopy, or videoflouroscopy as well as SLP examination

Front 19

TRUE OR FALSE
Surgical decisions for VPI are based on SLP perception of speech rather than Instrumental measures.

Back 19

TRUE
earliest surgery is done 31/2 to 4 years old

Front 20

VPI is a surgical disorder so are sucking, blowing , and speech exercises aeffective?

Back 20

NO they are not effective, but speech therapy should be done to prevent compensatory productions

Front 21

IN regards to VPI what stype of speech therapy can be done before and after surgery to help correct errors?

Back 21

ARTICULATION THERAPY

Front 22

What type of opening that occurs as a result of VPI has led to the search for some type of internal OBTURATION?

Back 22

VELOPHARYNGEAL OPENING

Front 23

If the velopharyngeal opening is considered small what is the diameter?

Back 23

10mm, (posterior pharyngeal wall augmentation has been used by some surgeons)

Front 24

what are the 2 types of pharyngeal Wall augmentation?

Back 24

Rolled flap and posterior pharyngeal wall augmenttaion(uses cartilage, fascia,fat,silicone,proplast,polytetraflourethylyene)

Front 25

rolled flap can only be changed to a sphincter
and posterior wall augmentations can be upgraded to?

Back 25

either a flap or sphincter

Front 26

WHAT IS THE MOST COMMONLY USED procedure to repair a VPI?

Back 26

pharyngeal flap (passive,soft tissue obturator paced in middle of VELO PORT)

Front 27

THE PHARYNGEAL FLAP INCLUDES the mucousal surface and ?

Back 27

UNDERLYING MUSCULATURE all teh way down to prevertebral fascia of spinal column

Front 28

The 2 techniques used to correct VPI are pharyngeal flap and sphincter pharyngoplasty both are designed to?

Back 28

REDUCE SIZE OF pharyngeal port so that during speech teh movement taht is present is sufficent for CLOSING THE ENTIRE PORT

Front 29

A passive soft tissue obturator that is placed in the middle velopharyngeal port is used in which surgical technique to correct Velo dysfunction?

Back 29

Pharyngoplasty

Front 30

The rolled flap is used as a surgical technique to improve?

Back 30

Pharyngeal wall augmentation

Front 31

What is one factor that determines sucess of a VPI

Back 31

VErtical position in nasopharynx- flap set high

Front 32

A cleft palate also changes the velopharyngeal sphincter true or false

Back 32

true

Front 33

What will result in less restriction of the anterior facial growth

Back 33

INTENTIONAL FISTULA