cleft palate and cleft lip

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.