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Cleft Palate and Cleft Lip. Alyssa Brzenski . Overview. Basic statistics of Cleft Lips and Cleft Palate Basic embryology of Cleft Lips and Palates Common Associated Syndromes Anesthetic Implications Common complications. Cleft Lip/Palate Statistics.

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Presentation Transcript
overview
Overview
  • Basic statistics of Cleft Lips and Cleft Palate
  • Basic embryology of Cleft Lips and Palates
  • Common Associated Syndromes
  • Anesthetic Implications
  • Common complications
cleft lip palate statistics
Cleft Lip/Palate Statistics

Merrit L. Understanding the Embryology and Genetics of Cleft Lip and Palate. Advances in Neonatal Care 2005; 5: 64-71.

risk factors
Risk Factors

Merrit L. Understanding the Embryology and Genetics of Cleft Lip and Palate. Advances in Neonatal Care 2005; 5: 64-71.

embryology
Embryology

Merrit L. Understanding the Embryology and Genetics of Cleft Lip and Palate. Advances in Neonatal Care 2005; 5: 64-71.

non syndromic orofascial clefts
Non-syndromic Orofascial Clefts

Mossey et al. Cleft Lip and Palate. Lancet 2009; 374: 1773-85.

pierre robin
Pierre Robin
  • Retrognathia
  • Glossoptosis
treacher collins
Treacher Collins
  • Mandibular hypoplasia
  • Triangular facies
  • Cleft palate
  • Microtia
  • Cardiac anomalies
  • Renal anomalies
  • Choanal atresia
goldenhar syndrome
Goldenhar Syndrome
  • Orbital Distortion
  • Mandibular Hypoplasia
  • Ear Anomaly
  • Nerve involvement (auricular, ophthalmologic, facial nerve)
  • Soft Tissue deficiency
should i expect a difficult intubation
Should I expect a difficult intubation?
  • 7% of children for Cleft lip or Cleft palate
    • Retrognathia
    • Age less than 6 months
    • Bilateral cleft
    • Wide Cleft
  • No difficulty ventilating
anesthesia
Anesthesia
  • Mask Induction
  • PIVx1
  • Intubate and place an oral rae
  • Balanced anesthetic
  • Post-op Pain control with long-acting narcotic
    • Infraorbital Nerve blocks for cle
  • Awake on extubation to protect airway
  • May have tounge stich
  • Avoid oral airways
infraorbital nerve block
Infraorbital Nerve Block

Pediatric Peripheral Nerve Blocks. NYSORA.

causes of upper airway obstruction
Causes of Upper Airway obstruction
  • Edema of the tongue from the Dingman retractor
  • Reduction in the size of the oropharynx
  • Excessive sedation
post operative palate fistula causes
Post-operative Palate Fistula Causes
  • Type of cleft
  • Wound tension
  • Type of repair
  • Single layer repair
  • Infection
  • Age of patient at time of repair
future procedures
Future Procedures
  • Ear Tubes
  • Palatoplasty- for velopharyngeal insufficiency
  • Alveolar Bone Graft (8-10 years of age)
  • Extensive orthodontic care
  • Speech Therapy
sources
Sources
  • Merrit L. Understanding the Embryology and Genetics of Cleft Lip and Palate. Advances in Neonatal Care 2005; 5: 64-71.
  • Arteau-Gauthier I, Leclerc JE, Godbout A. Can we predict a difficult intubation in cleft lip/palate patients? J Otolaryngol Head Neck Surg. 2011; 40:413-9.
  • Mossey PA, Little J, Munger RG, Dixon MJ, Shaw WC. Cleft lip and Palate. The Lancet. 2009; 374: 1773-85.
  • Loose JE, et al. A Successful Algorithm for Limiting Postoperative Fistulae following Palatal Procedures in the Patient with OrofacialClefting. Plastic and Reconstructive Surgery. 2008; 122: 544-54.
  • Shan Phua Y, ChalainT.Incidence of Oronasal Fistulae and Velopharyngeal Insufficiency After Cleft Palate Repair: An Audit of 211 Children Born Between 1990 and 2004. Cleft Palate-Craniofacial Journal. 2008; 45: 172-8.
  • Cote, Lerman, Todres. A Practice of Anesthesia for Infants and Children. 2009. 4th Ed.
  • Tremlett M. Anaesthesia for Cleft Lip and Palate Surgery. Current Anaesthesia and Critical Care. 2004; 15: 309-16.
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