CLEFT LIP AND PALATE

Clinical Features

  • Cleft lip results from abnormal development of the medial nasal and maxillary processes. This may present as unilateral, bilateral, or median cleft lip (rare). The clefts may be complete or incomplete.
  • Cleft palate results from a failure of fusion of the two palatine processes. These again may be unilateral, bilateral, or median.
  • Cleft lip and cleft palate may occur singly or in combination.
  • Cleft lip and palate may also be part of syndromes such as Trisomy 15 or 18.

In this case it is almost always associated with multiple congenital anomalies, with the prognosis depending on the associated anomalies. Effects on functions/ complications include:

  • Sucking and swallowing are greatly affected. This predisposes a child to malnutrition.
  • Speech development is impaired.
  • Hearing may be impaired because of recurrent acute or chronic otitis media.

Management

  • Counsel the parents that the defects can be repaired and explain when repair will be done.
  • If part of a syndrome counsel the mother clearly with respect to the implications of the associated anomalies.

Refer all children with cleft lip to a specialist.

Timing of repair
  • Operations for cleft lip may be done soon after birth or between 6 and 12 weeks.
  • Cleft palate repair is best at 12–15 months.
  • If repair is delayed it is important to ensure adequate nutrition. The baby with isolated cleft lip may be able to
    breastfeed but one with bilateral cleft lip and palate has difficulties in swallowing. Teach the mother how to feed the baby without choking.
  • Isolated cleft palate can be fitted with a prosthesis while waiting for repair
Purpose of treatment

The aim of treatment is to prevent or diminish complications and hence achieve:

  • Normal appearance
  • Well aligned teeth
  • Normal sucking and swallowing
  • Normal speech and normal hearing.