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Palatal Surgery
AKA ?
- Primary palatoplasty
- initial palatoplasty
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Primary Goal in Palatal Surgery
intact division between oral and nasal cavities
functional VP closure mechanism for speech
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Palatal surgery goal hope that it will?
- Facilitate feeding
- reduce URI's
- Normalize/improve otologic health
- Provide structural integrity for early speech learning (artic placements, oral direction of airflow, adequate resonance)
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Primary Veloplasty aka?
delayed hard palate closure
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Primary veloplasty is NOT another term for ?
initial palatoplasty
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Primary Veloplasty involves?
- early closure of the soft palate/velum and
- later closure of the hard palate
Ages vary across centers and studies
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Initial Palatoplasty (long standing popular procedures?
(4)
- Von Langenbeck (1861) -straight line repair
- V-Y pushback (1937)
- Bardach 2-flap procedure
- Furlow Z-plasty (1976) aka double opposing Z-plasty
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Bardach 2-flap procedure
modifies ?
Less denuding of ?
No ?
Includes ?
M: the V-Y
L: bone
pushback
levator reconstruction
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___ Procedure produces greater palatal length
sacrifices width
incorporated levator reconstruction
- Furlow procedure
- "double opposing Z-plasty"
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How to handle the alveolar cleft in complete cleft lip and palate?
Options (4)
The argument continues...
- 1) leave the alveolar cleft unoperated
- 2) close it by a primary gingivoperiostomy at the time of lip repair
- 3) close it by primary bone grafting (in deciduous dentition, using autogenous bone)
- 4) Close it by secondary bone grafting
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Secondary bone grafting to the alveolar cleft is done __?
- before eruption of the permanent canine (cuspid) teeth
- about 9-11 years
- teeth will erupt only into bone
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____ tx precedes the graft to align the two segments;
canine or lateral incisor will be guided to erupt into the grafted site?
Orthodontic tx
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A bone graft can also serve as?
the housing for dental (endosseous) implants
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Fistulas asr not just a "hole" in the palate they have ?
a 3-dimentional configuration
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Oronasal fistulas (fistulae) and surgical management
___:?from alveolus or labial sulcus into nasal cavity/nose
Nasolabial
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Oronasal fistulas (fistulae) and surgical management
____: sometimes intentional after surgical closure of palate?
Anterior hard palate into nose
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Oronasal fistulas (fistulae) and surgical management
___: ?
___: ?
juncture of hard and soft palate
soft palate proper
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Fistulas can be physically "closed" either through ?
- surgical management or
- maxillary obturator appliance
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SMCP is not always easily seen on ? and there may not be a ?
So clinician may assume there is no cleft to account for the "cleft type speech"
intraoral exam
palpable notch
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There may be visible physical signs of SMCP evident on intraoral exam but no?
associated speech disorder
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Surgical tx for SMCP is warranted only when there is ?
an associated speech problem, not on the basis of physical signs
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Persons with repaired clefts may require surgical advancement of the midface to ?
"normalize" or improve the maxilla-to-madible relationship
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A key question of maxillary advancement is the affect of this orthognathic surgery on?
speech
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In general surgery in individuals with repaired clefts
May improve:
May increase:
May cause:
May have:
*articulation errors related to malocclusion
*or have no effect on VP speech function/speech resonance
* a "return" of VP inadequacy
* no significant effect on articulation or resonance
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Facial Advancement surgery
___:?
Advancement of maxilla only
Transverse cut made just above roots of teeth
to improve facial and occlusion
Le Fort I Osteotomy
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Facial Advancement surgery
___:?
Mid-face moved forward (nasal bones and maxilla)
Improve aesthetics and occlusion
May improve nasal airway
Le Fort II Osteotomy
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Facial Advancement surgery
___:?
Major advancement of facial bones
From superior orbital rims down through maxilla
Improves occlusion and aesthetics, nasal airway
Le Fort III Osteotomy
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____:
Generic term for several different techniques used for moving facial bones, mandible or maxilla
Distraction osteogenesis
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Places internal or external metal device that is used to gradually push the divided bone segments apart in a slow, very controlled manner over a few weeks?
Distraction Osteogenesis
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A crew in the device is turned to gradually incease the gap created by surgery
Resulting gap is filled in by natural formation of new bone
Creates a mandible or maxilla that is longer in vertical plane, the horizontal plane or both depending on the presenting problem and desired result.
Distraction osteogenesis
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