Cleft lip & palate
It is a common finding in the newborn period, often signifying other underlying
pathology. Cleft lips occur in 1 in 750 white births (males > females 2:1) and cleft palates alone occur in 1 in 2500 births
(females > males 2:1).
- recurrence risks for future children (if no other congenital anomalies):
2-4%
The different classes are:
Group I: cleft lip only
Group II: cleft palate only
Group III: cleft lip, alveolus, and palate
Group IV: clefts of lip and alveolus
Clefts can occur due to:
- smoking in pregnancy (2x increase)
- phenytoin use in pregnancy (increase by 10x)
- genetic syndromes: Clefts of the secondary palate alone are more likely to
be associated with syndromes
- and of course, multifactorial reasons
Some syndromes associated with clefts are:
- Trisomy 13, 18
- Robin sequence
- Van der Woude's syndrome
- Treacher Collins syndrome
- Syndromes associated with microdeletions of chromosomes 22 q11.2: Velocardiofacial syndrome,
Digeorge
Complications Cleft Lip & Palate
- Parent bonding
- Feeding difficulties: Formula can reflux into the nasopharynx with resultant choking. A special nipple
with a larger opening can be used to aid in the feeding process. Feeding can be
a major problem with these children until they are repaired.
- Speech problems
- Pronunciation
- Nasal speech
- Recurrent otitis media & hearing loss
- Excessive dental decay common
Treatment
- Repair lip first @2-6 months of age (They often are revised at 4-5 y/o or
later for cosmesis)
- The palate is then repaired prior to 1 year old; timing is controversial
though 6-18 months
- Affects speech & facial growth: The best long-term results occur
when the palate is repaired before the development of meaningful connected
speech.
- Assess hearing
- At risk for OM from palatal muscle malalignment
- Monitor speech & development
- Genetic counseling
*bifid uvula is associated with
submucous
cleft palate -> characterized by a U-shaped notch, palpable in the
midline, at the juncture of the hard and soft portions of the palate. These
children may not have overt feeding difficulty, but are prone to eustachian tube
dysfunction and recurrent middle ear disease. speech is often mildly
hypernasal. Tonsillectomy and
adenoidectomy may be contraindicated in these patients because removal of the
adenoids can result in severe speech and swallowing dysfunction."
CHLA Chief Resident Pearl Feb 2005
CHLA Board Review 2005
Zitelli and Davis. 3rd edition.