Cleft Palate and Oronasal Fistula Repair

important principles for general oro-nasal surgery?

Gentle tissue handling

Preserve blood supply

Absorbable monofilament (e.g. monocryl, vicryl)

Tension relieving suture technique (e.g. interrupted, extra throws, wide bites)

Pre-operative planning

palate function?

separate oral and nasal cavities

most important foramen to be aware of in the maxilla located 1/2 between the dental arcade and midline at the level of the 4th premolar

major palatine foramen

major palatine foramen

what is indicated by the yellow star?

palatine fissure

what is A?

incisive papilla

what is B?

etiology of congenital cleft palates?

Multifactorial - spontaneous, inherited autosomal recessive, and/or intrauterine abnormalities

what animals are prone to congenital cleft palates?

brachycephalics

broad headed fetuses (e.g. chihuahua, dachshaunds)

congenital cleft palate is often associated with other concurrent abnormalites such as

cryptorchidism

hydrocephalus

epidermoid cysts

septal defects

microphthalmia

entropion

abnormal dentition

otitis media

most common types of cleft palates?

Upper lip (uni/bilateral)

Lateral rostral hard palate and lip

Midline hard and soft palate

Lateral soft palate

Soft palate hypoplasia

cleft palate that involves any of the structures cranial to the incisive foramen

primary cleft palate

cleft palate that involves the hard or soft palate, palatine, maxillary, or incisive bones, and mucosa on the oral and nasal sides

secondary cleft palate

how are cleft palates classified?

primary vs secondary vs both

unilateral vs bilateral

failure of fusion of the ? or ? results in a primary cleft palate

maxillary prominence

medial nasal prominence

failure of fusion of the ? results in a secondary cleft palate

opposing palatal shelves

clinical signs of primary cleft palate in newborns?

Cannot form seal and generate negative pressure for nursing

Poor weight gain

Rhinitis

how can you help a newborn with a primary cleft palate to nurse?

use bottles with long nipples

clinical signs of secondary cleft palate in newborns?

Cannot generate negative pressure for nursing

Poor weight gain

Rhinitis

Aspiration pneumonia

nutritional management for patient with secondary cleft palate prior to surgery?

oroesophageal tube

nasoesophageal tube

esophageal tube

gastric tube

patients must be at least ? old for cleft palate surgery

3-4 months

what cleft palates require surgery?

secondary cleft palates

principles for cleft palate surgery?

Flush nasal cavity

Tension relieving techniques

Must be airtight and well supported

Use absorbable monofilament

Gentle tissue handling

Use flaps for direct blood supply

Prepare owners - may need staged procedures or revisions

TF often times, exclusively primary cleft palates don't require surgery outside of cosmetic purposes

T

1 multiple choice option

primary cleft palate treatment that entails closure of the nasal floor and lip

cheilorrhaphy

secondary cleft palate treatment?

re-establish separation of nasal and oral cavity (lots of flap techniques)

acquired palatal defects are also known as

oronasal fistulas

what can cause an oronasal fistula (aka acquired palatal defect)?

Chronic infection

Trauma

Neoplasia

Iatrogenic

clinical signs of oronasal fistula?

sneezing

nasal discharge

pawing at mouth

oronasal fistula tx?

Double flaps

Buccal-based mucoperiosteeal advancement flap

Angularis oris buccal mucosal flap

Permanent or removable obturators or septal buttons

TF direct apposition is the go to treatment for oronasal fistulas

F

often fails

1 multiple choice option

principles of oronasal fistula surgical repair?

Use large flaps to minimize tension

Elevate connective tissue to preserve vascular supply

Debride to suture freshly incised epithelium

Avoid cautery and scissors

Make suture lines over connective tissue rather than the defect

post operative care for palatal defect surgery?

Canned food only

Place E-tube if possible

No toys

E-collar

Monitor for discharge, odor, discomfort

Pain management

complications associated with palatal defect surgery?

hemorrhage

dehiscence

acquired oronasal fistula formation

aspiration pneumonia

dyspnea

cosmesis

why can palate surgery fail?

exposure

tension/stress

infection

motion