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Embryological Development Disorders
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
CL: Cleft of structures anterior to incisive foramenUnilateral or bilateralComplete (involving alveolus), incomplete, or microform
Head and Neck
Published in Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno, Understanding Human Anatomy and Pathology, 2018
Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno
The orbital margin is formed by the frontal bone superiorly, zygomatic bone laterally (which includes the frontal process and temporal process) and the maxillary bone (or maxilla) medially, which also spans a good portion of the skull. The maxilla includes a frontal process along this orbital margin, an alveolar process above the teeth, an anterior nasal spine located at the bottom of the nasal region protruding out, an incisive foramen, and palatine process along the roof of the oral cavity, an anterior lacrimal crest bordering the anterior portion of the lacrimal groove, an infraorbital groove located on the floor of the orbit, and an infraorbital foramen just inferior to the orbital margin. The anterior nasal aperture is bounded by the nasal bones and maxillae. The nasal septum and the lacrimal bone (which includes the posterior lacrimal crest and lacrimal groove, all so-named because of their proximity to the lacrimal duct, which drains the tears of happiness that you will shed on completing your degree) can be seen in a frontal view of the anterior nasal aperture (Plates 3.7a and c and 3.8a and c).
Cleft Lip and Palate
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
David M. Wynne, Louisa Ferguson
In the 1950s Kernahan and Stark proposed an embryologically based system centred on clefting in relation to the incisive foramen. This was modified by Kernahan in 19713 who proposed a system based on the intraoral view of the palate. A ‘Y’ diagram representing the cleft is marked from 1 to 9, with the relevant areas marked dependent on the extent of the clefting (Figure 18.2).
Outcome of the ‘waiting until spontaneous extrusion’ strategy for long-term tympanostomy tube placement in children with cleft palate
Published in Acta Oto-Laryngologica, 2022
Yuri Nomura, Hidetoshi Oshima, Kazuhiro Nomura, Risako Kakuta, Ryoukichi Ikeda, Ai Kawamoto Hirano, Jun Ota, Tetsuaki Kawase, Yukio Katori
This study retrospectively reviewed the medical charts of all children with CP who regularly visited the Department of Otolaryngology-Head and Neck Surgery, Tohoku University Hospital, from December 2016 to November 2017 and who received long-term VT placement (Tympanic drain type B, #1542 KOKEN, Tokyo, Japan) for the first time at our department (Figure 1). Information, including age at the time of VT insertion, age at the time of VT loss (spontaneous extrusion or surgical removal), status of the tympanic membrane after the VT loss, cleft severity, and other coexisting congenital anomalies, was collected from children’s medical records. Regarding cleft severity, we divided the cleft into four categories according to the Veau classification [11]: clefts of the soft palate (I), clefts of the soft and hard palate up to the incisive foramen (II), clefts of the soft and hard palate extending unilaterally through the alveolus (III), and clefts of the soft and hard palate extending bilaterally through the alveolus (IV). Cleft severity increased in ascending order. Other coexisting congenital anomalies included the Pierre Robin sequence, CHARGE syndrome, and Down syndrome.
Bilateral suprazygomatic maxillary nerve block versus palatal block for cleft palate repair in children: A randomized controlled trial
Published in Egyptian Journal of Anaesthesia, 2018
Mohamed M. Abu Elyazed, Shaimaa F. Mostafa
A cotton swab was pressed opposite the first molar tooth then moved posteriorly until it fell into a depression, the GP foramen, situated at the junction of alveolar and palatine bone. A 23G needle was used to block GPN bilaterally just anterior to the GP foramen by injecting 0.5 ml local anesthetic solution 1 cm medial to 1st / 2nd maxillary molar at a depth < 1 cm without entering the canal. 0.5 ml local anesthetic solution was injected bilaterally to block LPN at the LP foramen, identified just lower and lateral to GP foramen, at a depth of less than 1 cm. NPN was blocked lateral to the incisive papilla using 0.5 ml of the solution at a depth of <1 cm. A single injection was sufficient to achieve bilateral block. In case of a complete cleft, the block was performed at the incisive papilla as the vessels will be emerging from the incisive foramen (IF).
Speech outcomes at 5 and 10 years of age after one-stage palatal repair with muscle reconstruction in children born with isolated cleft palate
Published in Journal of Plastic Surgery and Hand Surgery, 2018
Jill Nyberg, Erik Neovius, Anette Lohmander
CPO is defined as a cleft behind the incisive foramen. The purpose of cleft palate repair is to establish a separation between the oral and nasal cavities and to restore a functioning velopharyngeal closure, which is a prerequisite for normal speech production. Previous studies of speech outcomes after CPO repair involve different surgical techniques. For example, Pulkkinen et al. [11] compared Veau-Wardill-Kilner pushback with the Cronin modification technique, while also comparing two different cleft types (UCLP and CPO). Follow-up of the children in that study occurred at 3, 6, and 8 years of age. The authors found no significant differences in speech outcomes related to the different surgical technique. However, they demonstrated a significant difference in number of velopharyngeal flaps related to cleft type: 34% of children with CPO received a velopharyngeal flap, as compared to 13% in the UCLP group. Timmons et al. [1] performed a similar study, comparing different surgical techniques to repair the hard palate: the Veau technique and variations of von Langenbeck, or a combination of the two methods. The soft palate was repaired using the intravelar veloplasty in all children. The age range for speech assessment in their study was 5–12 years. The authors concluded that articulatory difficulties were more frequent in the UCLP group, whereas velopharyngeal problems, measured in terms of a high velopharyngeal flap rate, were significantly more common in the CPO group (with 37% receiving velopharygeal flap in the CPO group, vs none in the UCLP group).