Cleft Lip And Cleft Palate Important Notes
- Rule of 10 for cleft repair
- Weight should be 10 lbs
- Age – 10 weeks
- Haemoglobin – 10 gm%
- Surgeries used for cleft lip repair are
- Millard’s rotation advancement flap surgery
- Tennison-Randall triangular flap method
- Surgeries for cleft palate repair
- Ward Wills operation
- Y-V push-back palatoplasty
Cleft Lip And Cleft Palate Long Essays
Question 1. Classification of cleft lip and cleft palate and writing about their effects on eating and teeth
Answer:
Cleft Lip and Cleft Palate Classification:
- Venn’s classification
- Grade 1- cleft of soft palate only
- Grade 2- cleft of the hard and soft palate to the incisive foramen
- Grade 3- complete unilateral cleft of the soft and hard palate and the lips and alveolus
- Grade 4- complete bilateral cleft of the soft and hard palate and the lips and alveolus
- Davis and Ritchie’s classification
- Grade 1 – alveolar cleft
- Grade 2- post alveolar cleft
- Grade 3- alveolar cleft
- Kernahan and Stark’s classification
- Cleft of primary palate only
- Cleft of primary and secondary palate
- Cleft of secondary palate only
Cleft Lip and Cleft Palate Effects on Eating:
- Difficulty in feeding
- Difficulty in suckling on the nipple to get enough milk due to
- Intake of too much air while feeding
- Milk coming out through the nose
- For this feeding the baby in different positions and angles is recommended
Cleft Lip and Cleft Palate Effects on Teeth:
- The first teeth may be missing
- If present it may come out
- Overcrowding of teeth
- Overgrowth of the maxilla occurs compared to the mandible
- Needs orthodontic treatment
- Removal of some teeth is done
Read And Learn More: General Surgery Question and Answers
Question 2. Describe the congenital anomalies of the faciomaxillary region and describe the management of cleft palate
Answer:
Congenital Anomalies:
- Classification
- Congenital
- Harelip- causes
- Nonfusion of maxillary processes and medial nasal process
- Defective development of the frontonasal process
- Non fusion of two mandibular process
- Oblique facial cleft
- Arise due to confusion of the maxillary and lateral nasal process
- Macrostomia
- Due to inadequate fusion of maxillary and Mandibular process
- Microstomia
- Due to too much fusion
- Bifid nose
- Due to bifurcation of frontonasal process
- Mandibulofacial dysostosis
- Retrognathia or agnathia
- Hypertelorism- widely separated eyes
Management of Cleft Palate:
- Langenbeck’s operation
- Margins of the cleft are pared, the nasal septum is defined and separated off the upper surface of the cleft palate
- Mucoperiosteal flaps are lifted from the hard palate
- Two release incisions are made on each side just medial to the alveolar margins
- Mucoperiosteal flaps are mobilized
- The cleft is then repaired
Question 3. Describe the etiology, pathogenesis, clinical features, and management of cleft lip.
Answer:
Cleft Lip
A cleft lip is a congenital anomaly caused due to abnormal facial development during gestation
Cleft Lip Etiology:
- Hereditary
- Increased parental age
- Associated with other syndromes like Pierre Robin’s syndrome, ectodermal dysplasia
- Environmental factors
- Nutritional deficiency
- Radiation exposure
- Steroids injections
- Hypoxia
- Aspirin and other teratogenic drugs
Cleft Lip Pathogenesis:
- Various theories are put forward, they are
- Asynchronous development of various processes leading to fusion between them
- Failure of mesodermal development to form connective tissue bands across lines of fusion
- Interruption in the migration of the neural crest cells from the neural plate
Cleft Lip Clinical Features:
- Upper lip cleft is occasionally associated with the presence of two small blind tubes in the lower lip
- Lower lip cleft is rare
- Patient looks ugly
- Difficulty in suckling
- Teeth may come out through the gap
- Defective speech
- Deformed nostrils
Cleft Lip Management:
- Mirault- Blair operation- it is carried out in three stages
- Stage 1
- Adequate mobilization of the lip lateral to the cleft, the ala of the affected nostril, and a considerable part of the cheek is performed the lip is everted
- The incision is made in a groove between the lip and the maxilla
- Bleeding is checked by firm pressure
- Stage 2
- An ink mark is made on the lip
- The margins are made of raw
- Stage 3
- Skin flaps are sutured
- A rubber tube is introduced through the nostril
- The mucous membrane and the muscles are sutured separately with chromic catgut
- Finally, the skin is sutured
Question 4. Describe the etiology, pathogenesis, clinical features, and management of cleft palate.
Answer:
Cleft Palate
- It is a congenital disorder
- It involves a breach in the continuity of the palate formed during the development of the face
- Corrected entirely surgically
Cleft Palate Etiology:
- Hereditary
- Sex
- Maternal age
- Syndrome associated
- Environmental factors
Cleft Palate Pathogenesis:
- Various theories are put forward, they are
- Asynchronous development of various processes leading to fusion between them
- Failure of mesodermal development to form connective tissue bands across lines of fusion
- Interruption in the migration of the neural crest cells from the neural plate
Cleft Palate Clinical Features:
- Facial deformity
- Inability to feed
- Defective speech
- Nasal regurgitation of fluids
- Difficulty in hearing
- Defect in smelling
- Repeated respiratory tract infection
- There may be chances of aspiration pneumonia
- Dental problems
- Malformed teeth
- Malocclusion
- Congenital anomalies
Timing of Repair: 12-24 Months
Management Protocol of Cleft Patients:
- Immediately after birth
- Pediatric consultation
- First few weeks
- Hearing testing
- t10-12 weeks
- Surgical repair of lip
- Before 1 year or I8 months
- Surgical repair of palate
- 3 months after palate repair
- Speech and language repair
- 3-6 years
- Soft palate lengthening
- 5-6 years
- Pharyngeal surgery
- At 7 years
- Orthodontic treatment phase 1
- 9-11 years
- Pre-alveolar bone grafting
- 12 years or later
- Full orthodontic treatment phase 2
- 15-18 years
- Placement of implant
- 18-21 years
- Surgical advancement
- Final nose and lip revision
- Rhinoplasty
Cleft Lip And Cleft Palate Short Essays
Question 1. Cleft Lip
Answer:
Cleft Lip
A cleft lip is a congenital anomaly caused due to abnormal facial development during gestation
Cleft Lip Etiology:
- Hereditary
- Increased parental age
- Associated with other syndromes like Pierre Robin’s syndrome, ectodermal dysplasia
- Environmental factors
- Nutritional deficiency
- Radiation exposure
- Steroids injections
- Hypoxia
- Aspirin and other teratogenic drugs
Cleft lip Clinical Features:
- Upper lip cleft is occasionally associated with the presence of two small blind tubes in the lower lip
- Lower lip cleft is rare
- Patient looks ugly
- Difficulty in suckling
- Teeth may come out through the gap
- Defective speech
- Deformed nostrils
Cleft Lip Management:
- Mirault- Blair operation- it is carried out in three stages
- Stage 1
- Adequate mobilization of the lip lateral to the cleft, the ala of the affected nostril, and a considerable part of the cheek is performed the lip is everted
- The incision is made in a groove between the lip and the maxilla
- Bleeding is checked by firm pressure
- Stage 2
- An ink mark is made on the lip
- The margins are made of raw
- Stage 3
- Skin flaps are sutured
- A rubber tube is introduced through the nostril
- The mucous membrane and the muscles are sutured separately with chromic catgut
- Finally, the skin is sutured
Question 2. Cleft Palate
Answer:
Cleft Palate
- It is a congenital disorder
- It involves a breach in the continuity of the palate formed during the development of the face
- Corrected entirely surgically
Cleft Palate Etiology:
- Hereditary
- Sex
- Maternal age
- Syndrome associated
- Environmental factors
Cleft palate Clinical Features:
- Facial deformity
- Inability to feed
- Defective speech
- Nasal regurgitation of fluids
- Otological problems
- Dental problems
- Malformed teeth
- Malocclusion
- Congenital anomalies
Question 3. Development of face
Answer:
Development of face
- Around 4th week of intrauterine life, a prominent bulge develops on the ventral aspect of the embryo.
- Below it, there is a depression called stomadeum.
- The mesoderm covering the developing forebrain proliferates and forms a downward projection called the frontonasal process.
- The pharyngeal arches are laid down.
- The first branchial arch helps in the development of nasomaxillary complex.
- It forms the lateral border of the stomodeum.
- It gives off a bud from its dorsal end called nasal placodes.
- These placodes soon shrink to form nasal pits.
- At this stage, stomodeum is surrounded
- Above- frontonasal process
- Sides- maxillary process
- Below- Mandibular process
- The resultant nasal pit divides into the medial nasal process and lateral nasal process
- The maxillary process lust with the lateral nasal process and forms a nasolacrimal duet
- Lower lip
- The Mandibular processes of the two sides grow towards each other and fuse in the midline to form lower lip ami lower jaw
- Upper lip
- Formed by the two media nasal prominence and the two maxillary prominences
- Nose
- The maxillary process fuses with the medial nasal process, as a result, nasal pits are cut off from the stadium
- The frontonasal process becomes narrower to form nasal septum
- Cheeks
- Formed by the fusion of maxillary and Mandibular process
Question 4. Hare lip
Answer:
Hare lip
It is used to describe defects of the lip
Hare lip Causes:
- Nonfusion of maxillary processes with the medial nasal process- leads to a defect in the upper lip
- Defective development of frontonasal process- leads to midline defect of the upper lip
- Nonfusion of two mandibular processes- leads to midline defect of the lower lip
Cleft Lip And Cleft Palate Viva Voce
- A cleft lip is formed due to disturbance during 6 weeks of IU life
- A cleft palate is formed due to disturbances during 8 weeks of IU life
- A cleft lip is formed due to a defect in the fusion of the medial nasal process with the maxillary process
- A cleft palate is formed due to defective fusion of the premaxilla and two palatine processes
- Cleft lip repair begins at 3-6 months of age
- Cleft palate repair begins at 6-8 months of age