quality education for a healthier scotland multidisciplinary “ your face, my thane is as a book...
TRANSCRIPT
Quality Education for a Healthier Scotland
Multidisciplinary
“Your face, my thane is as a book…”
Macbeth
Promoting multiprofessional education and development in
Scottish maternity care
Quality Education for a Healthier Scotland
MultidisciplinaryObjective:
to detect the commonest abnormalities of the
• face• eye• ear and hearing• mouth to review their significance in the newborn and refer
appropriately.
Quality Education for a Healthier Scotland
Multidisciplinary Structure of the talk
•Face size vs Head•Symmetry and Position•Abnormal Eyes•Abnormal Ears•Nose and Lips•Abnormal Mouth•Abnormal Palate.
The Face
Quality Education for a Healthier Scotland
MultidisciplinaryThe Face:
Whole Picture
Quality Education for a Healthier Scotland
MultidisciplinarySymmetry and Position
Facial Palsy:Commoner afterforceps delivery Compression effect of the forceps on the branch of the facial nerve is often transient, and total recovery is usually anticipatedLook for other injuries.
Quality Education for a Healthier Scotland
MultidisciplinarySymmetry and Position
Asymmetric crying faces:
Congenital lack of normal innervation to mid faceAssociation with cardiac disease.
Quality Education for a Healthier Scotland
MultidisciplinaryThe Face: Trauma
Petechiae and bruising
Congestion common in face to pubes presentation
This bruising from bleeding under deep layers of scalp.
Quality Education for a Healthier Scotland
MultidisciplinaryThe Eye
•Normal Lids•Overall size•Symmetry/position•Round iris•Pupil/lens•Red light reflex/retina.
Normal eye
Quality Education for a Healthier Scotland
MultidisciplinaryThe Eyelids
Swelling from deliveryBruising Sub-aponeuroticInfection.
Quality Education for a Healthier Scotland
Multidisciplinary
The Eye
Coloboma:
Is a defect in the closing of the globe Ranges in severity from a notch in the lower part of the iris, making the pupil pear–shaped, to defects behind the iris in the fundus.
Quality Education for a Healthier Scotland
MultidisciplinaryThe Eye
With your ophthalmoscope set to +3 dioptres examine the cornea, iris and red reflex from a distance of approx 20 cm.
Quality Education for a Healthier Scotland
MultidisciplinaryRed reflex
An abnormal red reflex requires an urgent ophthalmologic opinion as it may represent a cataract or a mass of abnormal tissue.
Quality Education for a Healthier Scotland
MultidisciplinaryThe White Eye/Leukocoria Cataract
•The lens does not allow light through to illuminate the retina•May be tiny central dots.
Familiale.g. Galactokinase deficiency.
retinoblastoma
Retinoblastoma
Quality Education for a Healthier Scotland
MultidisciplinaryThe White Eye
Primary persistent vitreous
The solid tissue which formed the globe of the eye has persisted leaving permanent blindness and glaucoma.
Quality Education for a Healthier Scotland
MultidisciplinaryThe Eye
Congenital glaucoma
Obstruction to outflow of fluid from the eyeLarge hazy eye.
Quality Education for a Healthier Scotland
MultidisciplinaryThe Eye
Blocked Lacrimal Duct
Resolve <12 months>12 months refer to ophthalmologist for possible probing.
Quality Education for a Healthier Scotland
MultidisciplinaryDacrocystoceles
Quality Education for a Healthier Scotland
MultidisciplinarySquashed nose
Quality Education for a Healthier Scotland
MultidisciplinaryThe Nose
Choanal Atresia:
This can be one or both sides, bony or membranous
Usually presents with cyanosis when not crying.
Quality Education for a Healthier Scotland
MultidisciplinaryThe Nose
Snuffles
Noses can be partially blocked by vernix, blood, milk, etc.
Later low grade bacterial sepsis can be a problem.
Quality Education for a Healthier Scotland
MultidisciplinaryThe Ear
•Size•Shape•Position•Abnormalities•Extra bits.
Quality Education for a Healthier Scotland
MultidisciplinaryThe Ear Position
Low setNormal
Quality Education for a Healthier Scotland
MultidisciplinaryLow Set Ears
Quality Education for a Healthier Scotland
MultidisciplinaryThe Ear
ShapeBranchial arch anomalies with unusual ears, small mandiblesOto-renal syndromes with unusual ears, fistulae in neck and renal problems.
Quality Education for a Healthier Scotland
MultidisciplinaryThe Ear
SizeTrisomy 18 with small abnormal and low set earsPotter’ syndrome: Renal problems leading to oligohydramnios and a squashed baby.
Quality Education for a Healthier Scotland
Multidisciplinary
Ear position and shape
As in CHARGE syndrome.
Quality Education for a Healthier Scotland
MultidisciplinaryThe Ear
Pre-auricular pits or small fistulae.This baby’s mother had a similar pit but on the other side.There were no associated problems in this case.
Quality Education for a Healthier Scotland
MultidisciplinaryThe Ear
Skin tagsSimple tags are usually only cosmetic.Multiple or large tags can indicate hearing abnormalities or syndromes.Formal excision is usually recommended.
Quality Education for a Healthier Scotland
MultidisciplinaryThe Mouth
GumsTonguePalate
HardSoft.
Quality Education for a Healthier Scotland
Multidisciplinary
Tongue tie
CommonNot usually divided unless interfering with feedingPossible late association with speech problems.
Quality Education for a Healthier Scotland
MultidisciplinaryRanulae
Mucous inclusion cysts in the sublingual salivary glands on the floor of the infants mouth.They are usually small and will spontaneously regress. Larger ones need surgical removal.
Quality Education for a Healthier Scotland
MultidisciplinaryEpstein's Pearls
Nodules of epithelial cells resembling pearls just lateral to the midline on the hard palate (with a cluster at the junction of the hard and soft palate) are a normal finding.
Quality Education for a Healthier Scotland
Multidisciplinary
Neonatal teeth
Usually superficial in the gum and are removed to avoid maternal nipple problems.
Quality Education for a Healthier Scotland
MultidisciplinaryThe Mouth
Quality Education for a Healthier Scotland
Multidisciplinary Cleft Lip and or palate = 1 / 700 births
53% Isolated Cleft Soft (2°) Palate
Cleft palate80% Isolated deformityFamilial 12%Syndromic 8%
Affected sib = x 3.5 Two sibs = x 13.
Quality Education for a Healthier Scotland
MultidisciplinaryCleft PalateHigh Risk
Family HistoryMaternal exposure to teratrogens
incl. Anti-convulsants, steroids, alcoholSyndromes, e.g.Trisomy13,18Infant of diabetic mother (Χ2)Milk coming down nose during feeds.
Quality Education for a Healthier Scotland
MultidisciplinaryCleft palate
Quality Education for a Healthier Scotland
MultidisciplinaryCleft palate
Quality Education for a Healthier Scotland
MultidisciplinaryCleft uvula
A small posterior cleft palate is often missed. The bifid uvula seen here points towards a sub mucous cleft.
Quality Education for a Healthier Scotland
MultidisciplinaryCleft lip and palateUnilateral.
Quality Education for a Healthier Scotland
Multidisciplinary
Cleft lip and palateBilateral.
Quality Education for a Healthier Scotland
Multidisciplinary
Cleft Palate - Examination
Spontaneous visualisation bestPalpation with little finger of hard and soft palateVisualisation during gagHIGH RISK group only - use laryngoscope.
Quality Education for a Healthier Scotland
Multidisciplinary
Any questions?
Quality Education for a Healthier Scotland
MultidisciplinarySummary
Follow your instincts about a funny-looking face, but it may be familial!
One abnormality may follow another – remember associations esp. hearing.
If there is an increased risk of a cleft palate – formally view the soft palate.
Kind thanks to Janelle Aby, MD for many of the photographs