Cleft Lip and Palate

What anatomic feature divides the primary and secondary palates?

The incisive foramen.

Which muscles control the velum?

Levator veli palatini, tensor veli palatini, palatopharyngeus, palatoglossus, and musculus uvulae.

What are the anatomic features of a submucous cleft palate?

Bifid uvula, zona pellucida (muscle diastasis), V-notch to posterior palatal edge.

What is the probability of a patient with a submucous cleft having velopharyngeal dysfunction?

Trick question; patients with a submucous cleft who are asymptomatic are unlikely to present to medical professionals; the probability may be estimated at less than 10%.

What is the fundamental argument for surgical repair of the palate prior to 18 months of age?

Preservation of speech.

Which of the paired velar muscles is innervated by CN V, mandibular division?

Tensor veli palatini.

What is the reason to “stage” a palatal repair?

Delay of elevation of hard palatal mucoperiosteum may preserve midface growth potential.

What is the principal vascular supply to the palatal mucoperiosteal flap?

Greater palatine artery and vein.

What is the target of innervation of the greater and lesser palatine nerves?

They contribute sensory innervation to the palatal mucosa.

What is the motor innervation of the velar musculature except the tensor veli palatini?

CN X (vagus) via the pharyngeal plexus.

Which teeth usually originate in the premaxilla?

Central and lateral incisors.

Which tooth is most likely to be abnormal in cleft lip?

Lateral incisor.

What is the significance for lateral incisor agenesis in children with cleft patients?

It is a predictor for the need for maxillary advancement.

Where is the lesser palatine foramen?

Posterior to the greater palatine foramen within the palatine bone.

Which muscles of the palate control eustachian tube function?

Tensor veli palatini, and to a lesser extent, levator veli palatini.

What is the blood supply of the soft palate?

Ascending palatine artery is the major source.

What is the argument against gingivoperiosteoplasty in infancy?

Restricted maxillary growth.

What are the putative etiological factors in clefting?

Advanced paternal age, genetic, prenatal exposure to drugs, other environmental agents (multifactorial).

Which muscles form the anterior and posterior tonsillar pillars?

Palatoglossus and palatopharyngeus, respectively.

What is the main function of the levator veli palatini?

To elevate the soft palate.

Does the tensor veli palatini elevate the palate?

No, it primarily controls eustachian tube function and possibly contributes to swallowing.

What is the probability that a parent with nonsyndromic cleft lip/palate will have a child with a cleft?

4% for the first child, and 17% for the second child if the first child has a cleft.

What is the probability that parents without clefts who already have a child with a (nonsyndromic) cleft will have another child with a cleft?

4%.

What is the probability that a parent with Van Der Woude syndrome will have a child with a cleft?

50% (autosomal dominant inheritance: roughly follows Mendelian pattern).

What is a Simonart band?

Soft tissue at the nasal sill on the affected side; it is a feature that commonly defines “incomplete” cleft lip, but it is abnormal tissue and variable in thickness.

At what point in gestation is the error responsible for cleft lip and palate likely to occur?

Weeks 5 to 6 (lip) and 7 to 8 (palate).

In embryology, what are the five facial prominences that eventually form the face, and what is the error in cleft lip?

The five facial prominences: Frontonasal process, paired maxillary prominences, paired mandibular prominences.

The frontonasal process derives medial and lateral nasal processes; failure of fusion of one or both of the medial nasal processes and corresponding maxillary processes results in cleft lip.

What is the purpose of presurgical orthopedics?