Cleft Palate and Cleft Lip Alyssa Brzenski
Cleft Palate and Cleft Lip
Feb 24, 2016
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. - PowerPoint PPT Presentation
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Cleft Palate and Cleft LipAlyssa
Brzenski
OverviewBasic statistics of Cleft Lips and Cleft PalateBasic embryology of Cleft Lips and PalatesCommon Associated SyndromesAnesthetic ImplicationsCommon complications
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
Merrit L. Understanding the Embryology and Genetics of Cleft Lip and Palate. Advances in Neonatal Care 2005; 5: 64-71.
Embryology
Merrit L. Understanding the Embryology and Genetics of Cleft Lip and Palate. Advances in Neonatal Care 2005; 5: 64-71.
Facial Development
Cleft Lip Embryology
Cleft Palate
Non-syndromic Orofascial Clefts
Mossey et al. Cleft Lip and Palate. Lancet 2009; 374: 1773-85.
Pierre Robin RetrognathiaGlossoptosis
Treacher CollinsMandibular
hypoplasiaTriangular faciesCleft palateMicrotiaCardiac anomaliesRenal anomaliesChoanal atresia
Goldenhar SyndromeOrbital DistortionMandibular
HypoplasiaEar AnomalyNerve involvement
(auricular, ophthalmologic, facial nerve)
Soft Tissue deficiency
Should I expect a difficult intubation?7% of children for Cleft lip or Cleft palate
RetrognathiaAge less than 6 monthsBilateral cleftWide Cleft
No difficulty ventilating
AnesthesiaMask InductionPIVx1Intubate and place an oral raeBalanced anestheticPost-op Pain control with long-acting narcotic
Infraorbital Nerve blocks for cleAwake on extubation to protect airwayMay have tounge stichAvoid oral airways
Infraorbital Nerve Block
Pediatric Peripheral Nerve Blocks. NYSORA.
Causes of Upper Airway obstructionEdema of the tongue from the Dingman
retractorReduction in the size of the oropharynxExcessive sedation
Post-operative Palate Fistula CausesType of cleftWound tensionType of repairSingle layer repairInfectionAge of patient at time of repair
Future ProceduresEar TubesPalatoplasty- for velopharyngeal insufficiencyAlveolar Bone Graft (8-10 years of age)Extensive orthodontic careSpeech Therapy
Questions?
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 Orofacial Clefting. Plastic and Reconstructive Surgery. 2008; 122: 544-54. Shan Phua Y, Chalain T.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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