Authors:
Lee Shona M.
Sharma Aarti
A 3-month-old male infant is scheduled for repair of a cleft lip and palate. According to his pediatrician, the infant was born at full term and has no other medical problems.
A.1.
Describe the anatomic defects of a cleft palate and a cleft lip.
A.2.
What is the cause of an orofacial cleft?
A.3.
What is the incidence of an orofacial cleft?
A.4.
Discuss the pathophysiology of cleft lip and palate in neonates and in children older than 5 years.
A.5.
What other conditions are associated with orofacial clefts?
A.6.
What is Pierre Robin syndrome?
A.7.
What is Treacher Collins syndrome?
A.8.
What kind of specialized team care would these patients need?
A.9.
Discuss indications and timing of closure of cleft lip and palate.
A.10.
What is velopharyngeal incompetence, and how can it be diagnosed?
A.11.
What is the relation of tonsillectomy and adenoidectomy to velopharyngeal incompetence and postoperative obstructive breathing episodes?
B.1.
What information do you need before closure of a cleft lip and palate?
B.2.
What preoperative orders are needed?
B.3.
What airway equipment would you prepare in the operating room?
C.1.
What monitors will you need for cheiloplasty and palatoplasty?
C.2.
Discuss the induction and management of anesthesia for cleft lip and palate in this nonsyndromic, otherwise healthy infant.
C.3.
What positioning is recommended for cleft palate repair surgery?
C.4.
What are the reported complications of this type of surgery and anesthesia?
C.5.
Briefly describe the surgical techniques used to repair cleft defects.
C.6.
How does a pharyngeal flap affect anesthetic management or any subsequent anesthetic administered to this patient?
C.7.
What is an Abbe flap? What are its anesthetic implications?
C.8.
What are the crucial anesthetic concerns for cleft palate repair? What are the unique considerations of this surgical repair?
C.9.
What is laryngospasm? How would you make a diagnosis of laryngospasm?
C.10.
How would you manage the patient with laryngospasm?
D.1.
What complications of cleft lip and cleft palate surgery can be seen in the recovery room?
D.2.
How do you protect the airway postoperatively?
D.3.
How would you control postoperative pain in patients following a cleft lip and cleft palate repair? Describe a multimodal analgesic plan including regional anesthesia options.