Cleft palate and cleft lip
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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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Cleft Palate and Cleft Lip

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Cleft palate and cleft lip

Cleft Palate and Cleft Lip

Alyssa

Brzenski


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.


Facial development

Facial Development


Cleft lip embryology

Cleft Lip Embryology


Cleft palate

Cleft Palate


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


Questions

Questions?


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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