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Incidence
- Cleft Lip: 1 in 750 white births
- Isolated Cleft Palate: 1 in 2500 white births
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Family History (e.g. van der Woude Syndrome)
- Recurrence rate: 2-6% depending on history
- Ethnicity
- Asian patients have highest risk
- Black patients have lowest risk
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Epilepsy and maternal anticonvulsant use
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Embryonic Timing of lip and Palate defects
- Occurs prior to 37 days post-conception
- Cleft Lip
- Failed medial nasal and Maxillary closure
- Extension to Cleft Palate in 42% of cases
- Isolated Cleft Palate
- Failed fusion of palatal shelves
- Cleft Lip (with or without Cleft Palate)
- Variable involvement
- May involve only vermilion border
- Some cases extend into Palate and floor of nose
- May be associated with tooth abnormalities
- Unilateral or bilateral cleft
- Often associated with Columella abnormality
- Isolated Cleft Palate
- Midline defect starts at uvula
- May involve soft and Hard Palate and incisive foramen
- Pierre Robin Syndrome (Pierre Robin Sequence)
- Micrognathia
- U-Shaped Cleft Palate
- Glossoptosis
- EEC Syndrome
- Ectrodactyly (Split hand and foot)
- Ectodermal dysplasia
- Cleft Lip and Palate
- Trisomy 13 Syndrome
- Holoprosencephaly
- Amnion Rupture Sequence
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Hypothalamus and Pituitary abnormalities
- Isolated hypothalamic Hormone deficit
- Panhypopituitarism
- Septo-optic dysplasia
- Kallmann's Syndrome
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Breast Feeding infant
- See Lactation for Infant with Cleft Lip or Palate
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Bottle Feeding infant
- Consider plastic obturator to cover Palate
- Soft artificial nipple with large openings
- Squeezable bottle
- Perioperative Concerns
- Pre-operative criteria
- No signs of infection
- Child well hydrated
- Post-operative care
- Gentle nasal aspiration
- Fluid intake only for first 3 weeks after surgery
- Child must be kept from touching surgical site
- Cleft Lip Repair
- Z-Plasty repair with staggered Sutures minimizes scar
- Repaired at age 3 months
- Revision may be needed at age 4-5 years
- Corrective Nasal Surgery
- Repaired at lip repair or at adolescence
- Cleft Palate Repair
- Timing of repair variable based on type of defect
- Usually repaired before age 1 for normal speech
- Contoured speech bulb if surgery delayed after age 3
- Recurrent Otitis Media
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Hearing Loss
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Tooth malposition requiring orthodontics
- Speech deficits (may persist after repair)
- Difficulty with explosive sounds: "p, b, d, t, h, y"
- Difficulty with hissing sounds: "s, sh, ch"
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