Fusion of facial structures happens at what week #?
Week 7
Cleft palate results from failure of fusion of what two processes?
Median Nasal Process
and Maxillary Process
Is the dental lamina typically involved in cleft lip?
True
Predilections for cleft lip?
Bias towards left handers, asians, and males
Predilection for isolated cleft palate?
Females.
4 reasons for clefting?
socioeconomic
maternal illness
medications
maternal age
Lip Repair rule of tens
10 weeks of age
10 lbs
hemoglobin >10
WBC <10
Palate Repair
Occurs at 12 months. Speech is most critical driving force.
Residual fistula is common
Good chairside screening for speech therapy?
Mirror test
What to know about velpharyngeal flap?
Attach part of soft palate to posterior wall of pharynx
Narrow airway to teach child to eliminate nasal speech.
Can cause OSA and mouth breathing, complicates intubation.
5 indications for cleft palate patient to get a bone graft?
- produce continuous arch for stability
- improve osseous support of teeth adjacent to cleft
- allow bone for maxillary cuspid to erupt into
- support ala of nose
- close oronasal fistula
Timing for bone graft?
- Primary - before 2 years old
- Early secondary - between 2 and 5
- Mixed dentition early - prior to eruption of the lateral incisor
- Mixed dentition late - prior to eruption of cuspid
- Late secondary - after eruption of cuspid older than 12
What time is alveolar bone grafting most typically done?
Mixed dentition most often - before lateral incisor if present. Otherwise wait until later
