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Surgery

Cleft Palate Exam 2

TermDefinition
When does primary lip surgery take place? 8 - 10 wks
What is the rule of 10s? Hemoglobin 10 g/dl, weight 10 lbs., and 10 wks for surgery on babies cleft lip
Goals of first cleft surgery Accurate membrane union, symmetrical nasal floor, minimal scar, normal philtrum, no alar collapse
Which muscle is divided during 1st cleft surgery? Obicularis orisis
Types of lip repair Straight line, triangular repair, rotational advancement
Straight line repair Works for small cleft unilaterally, suture together in a straight line
Trianular repar Lengthens the philtrum, cut is farther down and suture into triangle, 2nd most common
Rotational Advancement Most widely used, 80% of surgeries. high up, pull each side together
How do they ensure skin comes together? Taping prior to surgery for better outcomes on lip
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
What affects candidacy for PNAM or NAM? Personal, affordability, access to follow-up, sleep apnea/med concerns
Latham appliance Rotate alveolar segment, bring it all together before surgery, minimize skin stretching and reduce possibility of bone graft later
What is more simple than Latham but does the same thing? Lip taping
Goals of palate repair Closure for normal growth, remove elevator from hard palate to create sling, bulk to velum, improve middle ear function
When does palate repair take place? 9-18 months
What is the early vs late issue? Some argue that boney anatomy can affect other structures so should do palate repair later
Why is early repair better? Less pervasive faulty arctic.
If there is no syndromes affecting... Should do surgery before 1 year if possible
3 main types of palate repair Von Langenbeck, V-Y, Furlow paltoplasty
Von Langenbeck Elevate mucoperisium, least common
V-Y Pushbak Retroposition and fill-in gap with material to grow
Furlow Palatoplasty Lengthen velum, most common, cut in z suture which causes velum to stretch, best if the palate is short
Why is secondary palate repair done? Close palatal fistula, correction of maxillary/mandibular issue, correct velopharyngeal dysfunction
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
Palatal/Oronasal Fistula Opening b/t oral and nasal cavities leading to nasal emissions or hypernasality, compensatory arctic., nasal regurgitation
What happens if palatal fistula is large? Hypernasality
What happens if palatal fistula is small/medium? Nasal emissions, whistle sound
Types of secondary palate repair Pharyngeal flap, Sphincterpharyngoplasty
Pharyngeal flap Midline flap with lateral post for breathing, inserted into PPW
When is the pharyngeal flap best recommended? Weak velum and strong lateral pharyngeal walls (lateral walls need to move to close, velum often hypotonic)
What is an age where good speech sample with nasal endoscope is possible to assess velum function for recommendation for secondary surgeries? 3-5ys
Complications associated with pharyngeal flap Obstructive sleep apnea (most common), snoring, anesthesia complications
Sphincterpharyngoplasty Pharyngeal flaps for more narrow sphincter
What secondary surgery is better for small VP gap? Sphincterpharyngoplasty
What secondary surgery is better for large VP gap? Pharygenal Flap
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
<4 mm Sphincterpharyngeoplasty
Created by: morganmc3
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