BOOK
Cleft Lip and Palate: Current Surgical Management, An Issue of Clinics in Plastic Surgery, E-Book
(2014)
Additional Information
Book Details
Abstract
Surgeon are presented an in-depth view of current surgical management of the cleft lip and palate patient in this issue of Clinics in Plastic Surgery. Focusing on aspects most relevant to plastic surgeons, each article offers an evidence-based assessment of current management options along with detailed descriptions of the author’s preferred surgical technique. Outcomes measures for each aspect of cleft care are discussed, along with an update on current inter-center outcomes studies in the US and abroad. This issue of The Clinic’s brings the current state of the art in cleft treatment to the practicing plastic surgeon, highlighting the changes and ongoing developments in the field. Topics include the nuanced management of Pierre Robin Sequence and Velo-cardio-facial syndrome, the continued evolution of naso-alveolar molding, and new developments in orthognathic surgery.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Cleft Lip and Palate:Current Surgical\rManagement | i | ||
| copyright\r | ii | ||
| Contributors | iii | ||
| Editors | iii | ||
| Authors | iii | ||
| Contents | vii | ||
| Clinics In Plastic Surgery\r | x | ||
| Preface\r | xi | ||
| Classification, Epidemiology, and Genetics of Orofacial Clefts | 149 | ||
| Key points | 149 | ||
| Historical perspective: terminology and classification | 149 | ||
| Classification | 150 | ||
| Measures of occurrence of orofacial clefts | 152 | ||
| Incidence Versus Prevalence | 152 | ||
| Suggested Measure of Disease Occurrence | 152 | ||
| Prevalence of Orofacial Clefts | 152 | ||
| Surveillance Systems | 153 | ||
| Risk factors for orofacial clefts | 153 | ||
| Sex, Race, and Ethnicity | 153 | ||
| Environmental Factors | 154 | ||
| Genetic Factors | 154 | ||
| OFC syndromes of known cause | 155 | ||
| Chromosomal syndromes | 155 | ||
| Mendelian syndromes | 156 | ||
| Teratogenic syndromes | 156 | ||
| Nonsyndromic OFCs of known cause | 156 | ||
| OFC syndromes and associations of unknown cause | 156 | ||
| Nonsyndromic OFCs of unknown cause | 156 | ||
| Pierre Robin sequence | 157 | ||
| Patient evaluation and family counseling | 157 | ||
| References | 158 | ||
| Further reading | 163 | ||
| Unilateral Cleft Lip Repair | 165 | ||
| Key points | 165 | ||
| Introduction | 165 | ||
| Embryology and epidemiology | 165 | ||
| Applied anatomy | 167 | ||
| Cleft classification | 168 | ||
| Anthropometric analysis and planning | 168 | ||
| Goals of surgery | 170 | ||
| Current practice | 170 | ||
| Presurgical Molding | 170 | ||
| Lip Adhesion | 170 | ||
| Triangular Repair | 170 | ||
| Rotation-Advancement: Millard and Modifications | 171 | ||
| Anatomic Subunit Repair | 172 | ||
| Postoperative care | 173 | ||
| Trends and controversies | 173 | ||
| Assessing outcomes of nasolabial repair | 174 | ||
| Summary | 174 | ||
| References | 174 | ||
| Modern Tenets for Repair of Bilateral Cleft Lip | 179 | ||
| Key points | 179 | ||
| Introduction | 179 | ||
| Contemporary principles | 180 | ||
| Maintain (or Establish) Symmetry | 180 | ||
| Prepare the Projecting Premaxilla | 180 | ||
| Anticipate Fourth-Dimensional Changes that Occur with Growth | 180 | ||
| Construct a Full Central Lip Using Lateral Labial Elements and Discard Prolabial Vermilion | 181 | ||
| Deepen the Gingivolabial Sulcus Using Premaxillary Mucosa | 181 | ||
| Establish Muscular Continuity Primarily | 181 | ||
| Address the Nasal Deformity Synchronously | 181 | ||
| Repair of bilateral complete cleft lip | 181 | ||
| Markings | 181 | ||
| Labial Dissection | 182 | ||
| Closure of the Nasal Floor | 182 | ||
| Gingivoperiosteoplasty and Mucosal Flap for Deepening of the Gingivolabial Sulcus | 183 | ||
| Labial Closure | 183 | ||
| Myrtiform Suture | 183 | ||
| Nasal Correction | 183 | ||
| Skin Closure | 184 | ||
| Postoperative Anthropometry | 184 | ||
| Postoperative Care | 184 | ||
| Technical variations | 185 | ||
| Bilateral Incomplete Cleft Lip | 185 | ||
| Bilateral Lesser-Form Cleft Lip | 185 | ||
| Asymmetric Bilateral Cleft Lip | 185 | ||
| Premaxillary setback | 186 | ||
| Cleft lip revisions | 186 | ||
| Summary | 187 | ||
| References | 187 | ||
| Cleft Palate Repair | 189 | ||
| Key points | 189 | ||
| Introduction | 189 | ||
| Pertinent anatomy | 189 | ||
| Goals of surgery | 191 | ||
| Patient assessment and perioperative considerations | 191 | ||
| Timing of the Repair | 191 | ||
| Feeding | 192 | ||
| Airway Compromise and Pierre Robin Sequence | 192 | ||
| Current practice and its origins | 193 | ||
| Repair of the Hard Palate | 193 | ||
| Repair of the Soft Palate | 193 | ||
| Two-Stage Palatoplasty | 193 | ||
| The authors’ approach: Furlow palatoplasty | 194 | ||
| Soft Palate | 194 | ||
| Markings | 194 | ||
| Incisions and flap elevation | 194 | ||
| Flap inset and closure | 200 | ||
| Hard Palate | 200 | ||
| Flap design | 200 | ||
| Hard palate closure and the alveolus | 202 | ||
| Postoperative care | 203 | ||
| Recent trends and controversies | 204 | ||
| Radical Intravelar Veloplasty | 204 | ||
| Does Furlow Palatoplasty Reliably Lengthen the Velum? | 205 | ||
| Approach to Rerepair of the Cleft Palate for VPI | 205 | ||
| Assessment of outcomes | 205 | ||
| Important Metrics | 205 | ||
| Speech Outcomes | 205 | ||
| Palatal Integrity | 207 | ||
| Summary | 208 | ||
| References | 208 | ||
| Surgical Considerations in Pierre Robin Sequence | 211 | ||
| Key points | 211 | ||
| Introduction | 211 | ||
| Anatomic changes in Pierre Robin sequence | 211 | ||
| General concepts for treatment | 212 | ||
| Treatment algorithm: the decision tree model | 213 | ||
| Outcomes of mandibular distraction and the decision tree model | 215 | ||
| Summary | 216 | ||
| References | 216 | ||
| Management of the Alveolar Cleft | 219 | ||
| Key points | 219 | ||
| Introduction | 219 | ||
| Presurgical infant orthopedics | 219 | ||
| Timing of Cleft Surgical Preparation | 220 | ||
| Correcting the unilateral deformity | 221 | ||
| Correcting the bilateral deformity | 222 | ||
| Secondary alveolar bone grafting in mixed dentition | 225 | ||
| Timing of bone grafting on the cleft maxilla | 226 | ||
| Source of bone-graft material | 227 | ||
| Iliac Crest for Secondary Bone Graft | 227 | ||
| Cranial Bone for Bone Graft | 227 | ||
| Tibia Bone for Bone Graft | 227 | ||
| Mandibular Symphysis for Bone Graft | 227 | ||
| Rib for Bone Graft | 227 | ||
| Bone Substitutes for Bone Graft | 227 | ||
| Platelet-rich Plasma Injections | 228 | ||
| Maxillary arch preparation before an alveolar bone-graft procedure | 228 | ||
| Orthodontic Planning | 228 | ||
| Maxillary Expansion | 229 | ||
| Management Protocol | 230 | ||
| Summary | 230 | ||
| References | 230 | ||
| Gingivoperiosteoplasty | 233 | ||
| Key points | 233 | ||
| Historical perspective | 233 | ||
| NAM-GPP | 234 | ||
| Patient selection and evaluation | 234 | ||
| Preoperative management | 234 | ||
| Performing GPP | 234 | ||
| Postoperative care | 236 | ||
| Trends and controversies | 236 | ||
| Summary | 238 | ||
| References | 239 | ||
| Speech Evaluation for Patients with Cleft Palate | 241 | ||
| Key points | 241 | ||
| Anatomy and physiology of the velopharyngeal valve | 241 | ||
| Velopharyngeal dysfunction | 242 | ||
| Perceptual evaluation of velopharyngeal function | 243 | ||
| Speech Samples | 243 | ||
| What is Assessed | 243 | ||
| Resonance | 243 | ||
| Nasal emission | 243 | ||
| Speech sound production | 244 | ||
| Phonation | 244 | ||
| Low-technology Tools for the Assessment | 244 | ||
| Mirror | 244 | ||
| Straw | 245 | ||
| Ratings | 245 | ||
| Video Recordings | 245 | ||
| Intraoral evaluation | 245 | ||
| Instrumental evaluation of velopharyngeal function | 246 | ||
| Nasometry | 246 | ||
| Speech Aerodynamics | 246 | ||
| Videofluoroscopic Speech Study | 247 | ||
| Nasopharyngoscopy | 247 | ||
| Differential diagnosis | 249 | ||
| Indications for speech therapy | 249 | ||
| Summary | 250 | ||
| Supplementary data | 250 | ||
| References | 250 | ||
| Surgical Management of Velopharyngeal Insufficiency | 253 | ||
| Key points | 253 | ||
| Overview | 253 | ||
| Historical perspective | 254 | ||
| Patient assessment | 254 | ||
| Patient History | 254 | ||
| Speech Assessment | 256 | ||
| Instrumental Assessment of the Velopharyngeal Mechanism | 256 | ||
| Current practice | 258 | ||
| Authors’ preferred technique | 258 | ||
| Preoperative Planning | 258 | ||
| Algorithmic Approach to Procedure Selection | 258 | ||
| Operative techniques | 259 | ||
| Furlow Palatoplasty/DOZ | 259 | ||
| High-inset Pharyngeal Flap | 261 | ||
| Sphincter Techniques | 262 | ||
| Prosthetics | 263 | ||
| Complications and avoidance | 263 | ||
| Furlow Palatoplasty/DOZ | 263 | ||
| Pharyngeal Flap | 263 | ||
| Early complications | 263 | ||
| Late complications | 265 | ||
| OSA | 265 | ||
| Diagnosis | 265 | ||
| Treatment | 265 | ||
| Sphincter Pharyngoplasty | 265 | ||
| Prosthetics | 266 | ||
| Controversies and recent trends | 266 | ||
| Controversies | 266 | ||
| Recent Trends | 266 | ||
| Measuring outcomes | 266 | ||
| Summary | 266 | ||
| References | 266 | ||
| Surgical Considerations in 22Q11.2 Deletion Syndrome | 271 | ||
| Key points | 271 | ||
| Introduction and historical perspective | 271 | ||
| General Overview of 22q11.2 Deletion Syndrome | 271 | ||
| Speech and Language Disorders in 22q11DS | 272 | ||
| VPD in 22q11DS: Structural and Neuromuscular Considerations | 272 | ||
| Patient assessment | 273 | ||
| Speech Assessment: Perceptual Evaluation and Instrumental Assessment | 273 | ||
| Imaging Recommendations | 273 | ||
| Timing of VPD Surgery | 274 | ||
| Current surgical practice | 274 | ||
| Authors’ surgical approach | 274 | ||
| Selection of Procedure | 274 | ||
| Preoperative Assessment | 277 | ||
| Surgical Technique | 277 | ||
| Measuring outcomes | 279 | ||
| Summary | 280 | ||
| References | 280 | ||
| Correction of the Cleft Nasal Deformity | 283 | ||
| Key points | 283 | ||
| Overview | 283 | ||
| Historical perspective | 283 | ||
| The cleft lip nasal deformity | 284 | ||
| Surgical technique | 286 | ||
| Primary Cleft Lip and Nasal Repair | 286 | ||
| Secondary Cleft Rhinoplasty | 289 | ||
| Planning | 289 | ||
| Patient assessment at skeletal maturity | 289 | ||
| Nasofacial analysis | 289 | ||
| Facial symmetry and proportion | 289 | ||
| The nasal dorsum | 290 | ||
| The lower third | 291 | ||
| Functional nasal examination | 291 | ||
| Secondary cleft rhinoplasty | 292 | ||
| Inferior turbinate reduction | 292 | ||
| Opening and exposure | 292 | ||
| Component reduction of the dorsum | 293 | ||
| Treatment of the septum | 293 | ||
| Spreader grafts | 293 | ||
| Nasal bone osteotomies | 294 | ||
| The lower third | 295 | ||
| Potter V-Y advancement | 295 | ||
| Shape and support of the lower lateral cartilages | 295 | ||
| Summary | 298 | ||
| References | 298 | ||
| Secondary Lip and Palate Surgery | 301 | ||
| Key points | 301 | ||
| Introduction | 301 | ||
| Secondary Cleft Lip Deformities Following a Unilateral Cleft Lip Repair | 301 | ||
| Surgical correction of secondary cleft lip deformities following unilateral cleft lip repair | 302 | ||
| Challenging Deformities | 303 | ||
| Secondary Cleft Lip Deformities Following a Bilateral Cleft Lip Repair | 304 | ||
| “Whistle” Deformity | 304 | ||
| Excessive Scarring | 305 | ||
| Goals of Reconstruction | 305 | ||
| Palatal Fistulas | 305 | ||
| Summary | 307 | ||
| References | 307 | ||
| Measuring Outcomes in Cleft Lip and Palate Treatment | 311 | ||
| Key points | 311 | ||
| Why measure outcomes? | 311 | ||
| Outcomes assessment and quality improvement requirements in cleft care | 312 | ||
| Outcomes assessment in the literature | 312 | ||
| Conceptualizing outcomes in cleft care | 314 | ||
| What to Measure in Cleft Outcomes? | 314 | ||
| When to Measure Cleft Outcomes? | 315 | ||
| How to Measure Cleft Outcomes? | 315 | ||
| Specific Measures | 316 | ||
| Performing outcome measurement | 316 | ||
| Summary and future directions on outcomes measurement | 317 | ||
| References | 317 | ||
| Index | 321 |