Congenital and Craniofacial Anomalies
Core concepts
Know the embryology and timing of facial development: branchial arches, fusion of facial prominences, and palatal shelf elevation. Cleft lip/palate classification (Veau), timing of repair (lip ~3–6 months, palate ~9–12 months), and the sequence of alveolar bone grafting (mixed dentition, ~6–9 years). Understand craniosynostosis syndromes and suture-specific head shapes (scaphocephaly, trigonocephaly, plagiocephaly, brachycephaly), plus when to operate (raised intracranial pressure, vision, airway). Know hemifacial microsomia (OMENS), Treacher Collins, and Pierre Robin sequence with airway management. Understand distraction osteogenesis principles and Le Fort advancement for syndromic midface hypoplasia.
Traps
Questions test suture-to-shape mapping and timing windows. Another trap is distinguishing Pierre Robin sequence (micrognathia, glossoptosis, cleft palate) from isolated cleft palate. Alveolar bone graft timing is a classic distractor-before eruption of the permanent canine. Also know that speech outcomes depend on palatal repair timing and velopharyngeal function, and that velopharyngeal insufficiency may need secondary surgery (pharyngeal flap, sphincter pharyngoplasty).
Worked example / rule of thumb
A neonate with micrognathia, glossoptosis, and cleft palate: manage airway first (prone positioning, nasopharyngeal airway, possibly distraction). Rule of thumb: lip before palate; palate before speech; alveolar graft when the canine erupts.