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Alyssa Brzenski

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

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

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

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

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Facial Development

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Cleft Lip Embryology

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Cleft Palate

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

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Pierre Robin Retrognathia Glossoptosis

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

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

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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

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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

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Infraorbital Nerve Block Pediatric Peripheral Nerve Blocks. NYSORA.

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

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

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

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Questions?

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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 Orofacial Clefting. Plastic and Reconstructive Surgery. 2008; 122: 544-54. Shan Phua Y, Chalain T.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. 4 th Ed. Tremlett M. Anaesthesia for Cleft Lip and Palate Surgery. Current Anaesthesia and Critical Care. 2004; 15: 309-16.