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At three weeks in utero, what primitive structures are present?
prosencephalon (forebrain), stomadeum (primitive mouth), and the buccopharyngeal membrane (separates mouth from foregut)
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At four weeks in utero, what structures are present?
Branchial ridges appear, and the buccopharyngeal membrane ruptures (then disappears)
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At five weeks in utero, what structures are present?
The fontonasal processes (beginning to descend and differentiate), and the maxillary processes (progressing toward the midline)
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At nine weeks in utero, what structure is present?
primary palate
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At ten weeks in utero, what structures are present?
Mandible (expanding), tongue (dropping), and maxillary processes (lifting and proceeding to the midline)
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At six weeks in utero, what structures are present?
Maxillary processes, and globular processes (which are converging at the midline)
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The 1st (mandibular) arch gives rise to what structures?
- Maxillary processes
- mandible
- anterior portion of the tongue
- muscles of mastication
- malleus and incus of the middle ear
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The 2nd (Hyoid) arch gives rise to what structures?
- lesser horns of the hyoid bine
- facial muscles
- styloid process
- stapes of the ME
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The 3rd branchial arch gives rise to what structures?
- remainder of the hyoid bone
- nasopharynx
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The 4th branchial arch gives rise to what structures?
- thyroid cartilege
- laryngeal archers
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The 5th branchial arch gives rise to what structures?
remainder of the larynx
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The geographical center of the primitive facial region is what structure?
stomodeum
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The superior boundary of the primitive facial region is what structure?
prosencephalon
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The inferior boundary of the primitive facial region is what structure?
mandibular process
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The posterior boundary of the primitive facial region is what structure?
buccopharyngeal membrane
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The roof of the nasal cavity is what structure?
cribiform plate of the ethmoid bone
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The floor of the nasal cavity is what structure
palatal processes of the maxillary and palatine bones
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The walls of the nasal cavity is what structure
labyrinth of the ethmoid bone
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The roof of the oral cavity is what structure
palatal processes of the maxillary and palatine bones
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The floor of the oral cavity is what structure
none - no bony structure for the floor of the oral cavity
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The walls of the oral cavity is what structure
- upper walls: maxillary bones
- lower walls: mandible
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The ectoderm (outermost) layer contributes to which structures?
- nervouse system
- epidermis
- epithelium of organs
- mucous lining of the oral cavity
- tooth enamel
- lining of the EAM
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The mesoderm (middle connective) layer contributes to which structures?
- cardiovascular system
- blood
- connective tissue
- cartilege and bone
- teeth (not enamel)
- muscle
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The endoderm (innermost protective) layer contributes to which structures?
- epithelium of lungs
- digestive tract
- eustacian tube & ME
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How is the primary palate formed?
fusion of the median nasal processes -> median palatine process -> primary palate
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The primary palate gives rise to which structures?
- lips
- alveolar ridge
- incisive foramen
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What are the boundaries of the primary palate?
- Anterior: vermillion border
- Posterior: incisive foramen
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A complete cleft of the primary palate can be described as?
a cleft from the vermillion border to the incisive foramen
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A minimal cleft of the primary palate can be described as?
just the vermillion border/microform cleft/submucous cleft/covert/occult
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A complete cleft of the primary palate causes the alar cartilege to flatten on which side?
The side of the cleft
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A complete cleft of the primary palate causes the nose to deviate to which side?
The non-cleft side
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A floating premaxilla can be the result of which type of cleft?
a complet bilateral cleft of the primary palate
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Can an incomplete bilateral cleft cause a floating premaxilla?
No, because it has one side to anchor itself to, which is enough
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How is the secondary palate formed?
Via hardening of the palatine shelves and progression to the midline
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The secondary palate gives rise to which structures?
- hard palate
- soft palate
- velum
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What are the boundaries of the secondary palate?
- Anterior: incisive foramen
- Posterior: Uvula
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A minimal cleft of the secondary palate can be described as?
bifid uvula, submucous cleft, covert/occult
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The Triad of Symptoms for VPI and CPI are what?
- Bifid uvula
- Bony notch of the hard palate
- Bluish median raphe
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What happens physiologically when there is a bilateral complete cleft of the secondary palate?
- The palatal plates lift medially
- the lateral nasal walls collapse medially towards the vomer bone
- the vomer remains untouched and unattached
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What happens physiologically when there is a unilateral complete cleft of the secondary palate?
- Forces exerted on cleft side cause that palatal plate to life medially
Wall of the nasal cavity on the cleft side is collapsed toward that side (the midline) - Vomer is attached to the noncleft side and deviated to that side
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VPI or CPI inefficiency can be caused by what?
A submucous cleft
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VPI and CPI inefficiency can be caused by 6 things. What are they?
- 1. short hard palate
- 2. Deep nasopharynx
- 3. Palatal immobility
- 4. Short soft palate
- 5. Inconsistent palatal motion
- 6. Ineffective palatal motion
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What is the incidence and prevalence of clefts?
10% and 10%
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What is the rate of children born with CP or CL in general population?
1:1000
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Why might overall rates of CP/CL have increased over time?
- 1. awareness
- 2. more pregnancies come to term
- 3. more high risk infants survive
- 4. surgical care is more advanced
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What is the sex difference for CP/Cl in males and females?
- Cleft lips are 2x as frequent in males
- Cleft palates are 2x as frequent in females
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What are some etiologies for CP/CL?
- Radiation exposure
- nutrition deficiency
- RH incompatibility
- Rubella
- Mumps
- Measles
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If neither parent has a cleft, what is the chances of their having a child with a cleft?
1:1000 (general population)
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If neither parent has a cleft but they have a child with a cleft, what is the chance their second child will have a cleft?
1:25, then 1:11 for the third child
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If one or both parents has a cleft, what is the chances of their having a child with a cleft?
1:25, then 1:6 for the second child, and 1:6 for the rest
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Which syndrome has micrognathia, a U-shaped cleft of the secondary palate, glossoptosis, and respiratory and feeding problems?
Pierre Robin Sequence (1:30,000)
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Which syndrome has antimongoloid slant to the eye, underdeveloped maxillary, extremely wide angle mouth, atresia of the external auditory cnal, cleft papate, VP inefficiency?
Treacher Collins (Mandibulofacial Dysostosis, 1:50,000)
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