Describe APGAR score
Apgar scores of 0-3 are critically low, especially in term and late-preterm infants
Apgar scores of 4-6 are below normal, and indicate that the baby likely requires medical intervention
Apgar scores of 7+ are considered normal (1, 3)
Incidence of CLP per 1000
- Asian 3.2
- Caucasian 1.4
- African 0.43
What gestational age can CLP be diagnosed
16 weeks via ultrasound
What screening tool should be employed for infant with CLP
Echocardiogram
R/o valve disease or great vessel transposition
CLP laterality prevalence
2:1 on left
When does cleft lip (CL) develop
During 3rd-7th weeks
When does cleft palate form?
During 5th-12th weeks
What processes fail to fuse in CL?
CL = failed fusion of medial nasal and maxillary processes
What fails to attach / align in CP?
CP = failed attachment and alignment of levator veli, tensor veli palatini, uvular, palatopharygeus, and palatoglossus muscles
What forms primary palate? Secondary Palate?
Primary palate = premaxila = lip, alveolar arch, palate anterior to incisive foramen
Secondary palate = hard and soft palates posterior to incisive foramen
Rule of ten’s for safe infant anesthesia
- 10 weeks old
- >10lbs
- Hg >10
When is primary lip repair performed?
Advantages for later repair?
10-14 weeks
- More prominent landmarks
- Easier
- Better esthetic outcome
When is CP repair done?
What developmental milestone guides timing?
What are advantages for later repair?
9-18 months
Speech development. If child has mental delay and speech is anticipated much later, than CP repair should be delayed
- Decreased incidence of maxillary hypoplasia
What is incidence of VPI following CP repair?
20% VPI
diagnosed 3-5 years old
When is alveolar grafting performed?
Mixed dentition age 8-11
Canine root 2/3 formed
When is orthognathic surgery performed
If needed it is done age 14-18
When is lip and nasal revision surgery done?
After age 5 and only for severe deformities
When is rhinoplasty done?
6-12 months after orthognathic surgery, if needed. This is because maxillary advacement often improves nasal esthetics.
What is most common technique for unilateral CL repair?
Millard rotation-advancement technique
- 3 layers
- Orbicularis oris muscle is made to form continous sphincter
- Incisions lie in natural contours
https://www.youtube.com/watch?v=kVZ0vlW3c7Y
What can be done during CL repair to lengthen columella or create nasal sill?
C-flap
https://www.youtube.com/watch?v=eZfQXT_A8Jo
