1. Nager syndrome symptoms
    • AKA preaxial acrofacial dysostosis
    • micrognathia
    • zygomatic hypoplasia
    • downward slantting palpebral fissures from hypoplastic orbitomalar
    • dolichofacial
    • cleft palate
    • preaxial limb deformities. 
  2. Nager common features
    • Zygomatic hypoplasia +
    • Downslanting palpeblar fissures +
    • Lower eyelid colobomas
    • Mandibular hypoplasia +
    • External ear malformation +
    • Limbs
    • Thumb aplasia or hypoplasia
    • Radial defects +
    • Others
    • Genitourinary abnormalities +
    • Reduced stature +
  3. Nager development defect origins
    • branchial arch 1,2
    • limb buds
  4. Cleft palate
    failure of fusion of the lateral palatine processes, the nasal septum, and/or the median palatine processes (formation of the secondary palate).
  5. Cleft Lip
    failure of fusion of the maxillary and medial nasal processes (formation of the primary palate).
  6. Cleft lip surgery
    • rule of 10s
    • 10 weeks of age; weighs at least 10 pounds, and has at least 10g hemoglobin
  7. Millard Surgery
    The rotation-advancement procedure for cleft lip repair, also known as the Millard Repair, is designed to create a softer, more natural-looking lip. Surgery performed prior to the Millard procedure involved pulling both sides of the cleft lip together resulting in a tightly closed upper lip. The Millard Procedure rotates the tissue and creates a "Z" shaped scar instead. The "Z" shape gives the tissue more elasticity, resulting in greater flexibility and restoration of the Cupid's bow.[2]
  8. Cleft palate surgery,
    • between 6 and 12 months.
    • Approximately 20–25% only require one palatal surgery to achieve a competent velopharyngeal valve capable of producing normal, non-hypernasal speech.
  9. Latham appliance.
    surgically inserted by use of pins during the child's 4th or 5th month. After it is in place, the doctor, or parents, turn a screw daily to bring the cleft together to assist with future lip and/or palate repair.
  10. pharyngeal flap
    surgery for speech correction done at 3-4 yrs old
  11. alveolar bone graft (cleft palate)
    • done 5-9 yrs old if necessary
    • may need palatal expansion
Card Set
craniofacial, nager