Clefts-0005 - Clefts of the Lip, Alveolus and Palate...

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Clefts of the Lip, Alveolus and Palate Michael E. Prater, MD Norman R. Friedman, MD
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Overview Introduction Basic Science Timetable of Events neonatal toddler gradeschool teenage Surgical Procedures Conclusion/Future Directions
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Introduction A TEAM APPROACH IS REQUIRED pediatrician surgeon OMFS dentist ENT psychiatrist speech nurse coordinator
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Introduction Most common congenital malformation of  H and N (1:1000 in US; 1:600 in UK) Second most common overall (behind  club foot)
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Epidemiology Syndromic CLAP associated with more than 300 malformations Pierre Robin Sequence; Treacher-Collins,  Trisomies 13,18,21, Apert’s, Stickler’s,  Waardenburg’s Nonsyndromic CLAP diagnosis of exclusion
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Syndromic CLAP Single Gene Transmission trisomies 21, 13, 18 Teratogenesis fetal alcohol syndrome Thalidomide Environmental factors materal diabetes amniotic band syndrome
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Epidemiology: continued Isolated cleft palate genetically distinct  from isolated cleft lip or CLAP same among all ethnic groups (1:2000, M:F  1:2) Isolated CL or CLAP different among ethnic groups American Indians:   3.6:1000 (m:f 2:1) Asians 3:1000  (m:f 2:1) African American 0.3:1000 (m:f 2:1)
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Embryology Primary versus secondary palate divided by incisive foramen primary palate develops 4-5 wks secondary palate develops 8-9 wks Primary palate mesodermal proliferation of frontonasal and  maxillary processes never a cleft in normal development
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Embryology: continued Secondary palate medial ingrowth of lateral maxillae with  midline fusion always a cleft in normal development macroglossia, micrognathia may provide  anatomical barriers to fusion
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Veau Classification - 1931  Veau Class I:  isolated soft palate cleft Veau Class II:  isolated hard and soft palate  Veau Class III:  unilateral CLAP
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This note was uploaded on 12/24/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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Clefts-0005 - Clefts of the Lip, Alveolus and Palate...

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