Cleft Lip and Palate
Definition
Clinical Considerations - Cleft Lip
Counselling (explanation: genetic background, syndromes)
- Normal to high intelligence
- Normal life
Cleft pals (group)
Feedings (usually do well. sometimes - neuromuscular disorder)
Registration in cleft lip and palate scheme (orthodontics + dental up to 28y)
Early orthodontic intervention (0-3mo. Operate only >3 mo – blood loss, small size)
Clinical Considerations - Cleft Palate
As above, plus:
Management
Operative schedule - Cleft Lip:
- Rule of 12: 12w old, Hb 12g/dl, 12lbs
Operative schedule - Cleft Palate:
Source
Dr Boyd 2014
- Types:
- Unilateral/ bilateral + complete/incomplete
- Incomplete = nostril seal intact
- Bilateral = possibly less optimal results
Clinical Considerations - Cleft Lip
Counselling (explanation: genetic background, syndromes)
- Normal to high intelligence
- Normal life
Cleft pals (group)
Feedings (usually do well. sometimes - neuromuscular disorder)
Registration in cleft lip and palate scheme (orthodontics + dental up to 28y)
Early orthodontic intervention (0-3mo. Operate only >3 mo – blood loss, small size)
Clinical Considerations - Cleft Palate
As above, plus:
- Sub mucous cleft
- Ears
- Speech
Management
Operative schedule - Cleft Lip:
- Lip @ 3 mo
- Rule of 12: 12w old, Hb 12g/dl, 12lbs
- Palate @ 9 mo
- Grommets
- Pharyngoplasty @ 4y (after speech patho intervention)
- Bone grafts 10y onwards
- Palatal fistula repair (leaking food)
- Nasal revision
- Lip revision
- Revision of older patients (eg Abbe flap)
Operative schedule - Cleft Palate:
- @9mo
- GA 1 hour
- Muscle
- Central flap
- Fistula rate
- Later ? Pharyngoplasty (5% chance)
Source
Dr Boyd 2014