Cleft Palate Exam 2
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| When does primary lip surgery take place? | 8 - 10 wks
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| What is the rule of 10s? | Hemoglobin 10 g/dl, weight 10 lbs., and 10 wks for surgery on babies cleft lip
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| Goals of first cleft surgery | Accurate membrane union, symmetrical nasal floor, minimal scar, normal philtrum, no alar collapse
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| Which muscle is divided during 1st cleft surgery? | Obicularis orisis
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| Types of lip repair | Straight line, triangular repair, rotational advancement
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| Straight line repair | Works for small cleft unilaterally, suture together in a straight line
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| Trianular repar | Lengthens the philtrum, cut is farther down and suture into triangle, 2nd most common
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| Rotational Advancement | Most widely used, 80% of surgeries. high up, pull each side together
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| How do they ensure skin comes together? | Taping prior to surgery for better outcomes on lip
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| NAM or PNAM | Shapes and improves the position of the nose symmetry before surgery, given during 1st week of life, wear 24 hrs./day, dental visits weekly, new 3-6 months
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| What affects candidacy for PNAM or NAM? | Personal, affordability, access to follow-up, sleep apnea/med concerns
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| Latham appliance | Rotate alveolar segment, bring it all together before surgery, minimize skin stretching and reduce possibility of bone graft later
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| What is more simple than Latham but does the same thing? | Lip taping
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| Goals of palate repair | Closure for normal growth, remove elevator from hard palate to create sling, bulk to velum, improve middle ear function
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| When does palate repair take place? | 9-18 months
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| What is the early vs late issue? | Some argue that boney anatomy can affect other structures so should do palate repair later
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| Why is early repair better? | Less pervasive faulty arctic.
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| If there is no syndromes affecting... | Should do surgery before 1 year if possible
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| 3 main types of palate repair | Von Langenbeck, V-Y, Furlow paltoplasty
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| Von Langenbeck | Elevate mucoperisium, least common
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| V-Y Pushbak | Retroposition and fill-in gap with material to grow
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| Furlow Palatoplasty | Lengthen velum, most common, cut in z suture which causes velum to stretch, best if the palate is short
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| Why is secondary palate repair done? | Close palatal fistula, correction of maxillary/mandibular issue, correct velopharyngeal dysfunction
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| What is more important for SLP, primary or secondary surgery? | Secondary, VP closure, often this is for speech, prior to 12 months they aren't talking
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| Palatal/Oronasal Fistula | Opening b/t oral and nasal cavities leading to nasal emissions or hypernasality, compensatory arctic., nasal regurgitation
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| What happens if palatal fistula is large? | Hypernasality
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| What happens if palatal fistula is small/medium? | Nasal emissions, whistle sound
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| Types of secondary palate repair | Pharyngeal flap, Sphincterpharyngoplasty
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| Pharyngeal flap | Midline flap with lateral post for breathing, inserted into PPW
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| When is the pharyngeal flap best recommended? | Weak velum and strong lateral pharyngeal walls (lateral walls need to move to close, velum often hypotonic)
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| What is an age where good speech sample with nasal endoscope is possible to assess velum function for recommendation for secondary surgeries? | 3-5ys
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| Complications associated with pharyngeal flap | Obstructive sleep apnea (most common), snoring, anesthesia complications
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| Sphincterpharyngoplasty | Pharyngeal flaps for more narrow sphincter
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| What secondary surgery is better for small VP gap? | Sphincterpharyngoplasty
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| What secondary surgery is better for large VP gap? | Pharygenal Flap
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| When is the sphincterpharyngoplasty best recommended? | Poor pharyngeal wall movement but good velar movement, essential this surgery makes sphincter smaller by creating bulk on sides of lateral pharyngeal walls
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| <4 mm | Sphincterpharyngeoplasty
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