Cleft lip and cleft palate

▪ Cleft lip and cleft palate are distinct conditions with distinct causes, though they
frequently occur together.

▪ The lip and palate form during the fifth-sixth week of embryonic development
through a series of fusions:
- The first step is fusion of the two medial nasal prominences to form the midline
intermaxillary segment.

- The left and right maxillary prominences then fuse with the midline intermaxillary
segment to form the upper lip, the four medial maxillary teeth, and the primary palate.

- The secondary palate forms from palatine shelves (maxillary prominence), which fuse in
the midline, posterior to the incisive foramen.

- The primary and secondary palates fuse at the incisive foramen to form the definitive
hard palate.

▪ If one of the maxillary prominences fails to fuse with the intermaxillary segment, a
unilateral cleft lip results (For unknown reasons, this occurs more commonly on the left).

▪ If both maxillary prominences fail to fuse with the intermaxillary segment, a bilateral
cleft lip result.

▪ Cleft palate results when the palatine shelves of the maxillary prominence fail to
properly fuse with one another or with the primary palate.

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 Congenital torticollis

▪ It typically develops by 2 to 4 weeks of age.

▪ It is most commonly caused by birth trauma (breech delivery) or malposition of the head
in utero (due to fetal macrosomia or oligohydramnios), both of which can result in
sternocleidomastoid muscle (SCM) injury and fibrosis.

▪ Rarely, it can be due to cervical spine deformities.

▪ Children with congenital torticollis may have additional musculoskeletal anomalies,

including hip dysplasia and talipes equinovarus (clubfoot).

▪ The diagnosis of congenital torticollis is made clinically.

▪ On physical examination, the head is tilted toward the affected side with the chin
pointed away from the contracture.

▪ A soft-tissue mass may be palpable in the inferior one-third of the affected SCM.

▪ Most cases resolve with conservative therapy and stretching exercises.