Cleft Palate and Cleft Lip

1. Cleft Palate and Cleft Lip Alyssa Brzenski

2. Overview • Basic statistics of Cleft Lips and Cleft Palate • Basic embryology of Cleft Lips and Palates • Common Associated Syndromes • Anesthetic Implications • Common complications

10. Cleft Lip/Palate Statistics Merrit L. Understanding the Embryology and Genetics of Cleft Lip and Palate. Advances in Neonatal Care 2005; 5: 64-71.

11. Risk Factors Merrit L. Understanding the Embryology and Genetics of Cleft Lip and Palate. Advances in Neonatal Care 2005; 5: 64-71.

12. Embryology Merrit L. Understanding the Embryology and Genetics of Cleft Lip and Palate. Advances in Neonatal Care 2005; 5: 64-71.

13. Facial Development

14. Cleft Lip Embryology

15. Cleft Palate

16. Non-syndromic Orofascial Clefts Mossey et al. Cleft Lip and Palate. Lancet 2009; 374: 1773-85.

17. Pierre Robin • Retrognathia • Glossoptosis

18. Treacher Collins • Mandibular hypoplasia • Triangular facies • Cleft palate • Microtia • Cardiac anomalies • Renal anomalies • Choanal atresia

19. Goldenhar Syndrome • Orbital Distortion • Mandibular Hypoplasia • Ear Anomaly • Nerve involvement (auricular, ophthalmologic, facial nerve) • Soft Tissue deficiency

20. Should I expect a difficult intubation? • 7% of children for Cleft lip or Cleft palate • Retrognathia • Age less than 6 months • Bilateral cleft • Wide Cleft • No difficulty ventilating

21. Anesthesia • Mask Induction • PIVx1 • Intubate and place an oral rae • Balanced anesthetic • Post-op Pain control with long-acting narcotic • Infraorbital Nerve blocks for cle • Awake on extubation to protect airway • May have tounge stich • Avoid oral airways

22. Infraorbital Nerve Block Pediatric Peripheral Nerve Blocks. NYSORA.

23. Causes of Upper Airway obstruction • Edema of the tongue from the Dingman retractor • Reduction in the size of the oropharynx • Excessive sedation

25. Post-operative Palate Fistula Causes • Type of cleft • Wound tension • Type of repair • Single layer repair • Infection • Age of patient at time of repair

26. Future Procedures • Ear Tubes • Palatoplasty- for velopharyngeal insufficiency • Alveolar Bone Graft (8-10 years of age) • Extensive orthodontic care • Speech Therapy

27. Questions?

28. 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 OrofacialClefting. Plastic and Reconstructive Surgery. 2008; 122: 544-54. • Shan Phua Y, ChalainT.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.