Congenital malformation – cleft palate

Dr.Dejen G.(MD)
2020
Dire Dawa
• INTRODUCTION
• Clefts of the lip and palate are the among
the most common congenital birth anomalies.

• The reported incidence varies between 0.41/

1000 and 3.7/ 11000 live births.
• The condition usually presents as an isolated
anomaly (nonsyndromic cleft lip and/or
palate) but may be associated with other
congenital defects (syndromic cleft lip and/or
palate)
CLASSIFICATION
• Many different classification systems of varying
complex­ity have been proposed for cleft lip and
palate.

• The simple ones are easy to use, but fail to

distinguish between phenotypic characteristics
that may be significant with regard to
aetiology and treatment outcome
EPIDEMIOLOGY
• There are racial differences in incidence
with the highest incidence of cleft lip and
palate reported in Native Americans
(3.711000 live births) and the lowest in
children of Afro-Carribean descent
• Cleft lip with or without cleft palate (CLIP) is
more common in boys.

• The more severe the defect, the greater the

proportion of males affected.

• The male to female ratio is 2:1 for cleft lip and

palate reducing to 1.5: 1 for isolated cleft lip
(CL) .
• Clefts of the lip may be incomplete or
complete, unilateral or bilateral. Unilateral cleft
lip occurs twice as commonly on the left side.

• Approximately 10-30 percent are associated

with skin bridges that connect the medial and
lateral cleft elements known as Simonart's
bands.
• Cleft palate (CP) may involve just the soft palate or
extend into the hard palate.

• Submucous cleft of the soft palate where the mucosa

is intact but the underlying tissues are 'cleft' has
been reported in approximately 1 in 1200 to 1 in
2000 births
Causes of palate
• Genetic
• Environmetal
– Smoking
– Alcohol
– Anticonvulsants
– steroids taken during pregnancy
• Syndromic
MANAGEMENT OF CLEFT LIP AND PALATE
Diagnosis
• In the past, clefts of the lip and palate were
diagnosed at birth.

• This is still largely true to day. One exception is the

diagnosis of submucous cleft palate which usually
only becomes manifest if and when speech
problems
• Diagnosis is often delayed until after the
age of three years and sometimes much
later.
• Early identification of submucous cleft
palate would allow for good prognosis
• The mere presence of a submucous cleft is not in
itself an indication for treatment.

• Careful monitoring of speech development is

essential.

• Identification of feeding difficulties in the neonatal

period may be a marker for the subsequent
development
• During the last decade, technological advances in
obstetric ultrasound have facilitated prenatal
diagnosis of cleft lip and palate

• Clef t lip can now be accurately detected by

transvaginal sonography as early as 13-16 weeks
gestation.
• Prenatal diagnosis in cleft lip and palate
has inevitably raised difficult ethical issues.
General principles

• Management of patients with cleft lip and palate

requires a multidisciplinary approach delivered by
a team.

• This will ideally include a nurse specialist,

paediatrician, feeding specialist, speech and
language therapist, cleft surgeon, orthodontist,
audiologist, otolaryngologist and psychologist
• CP/CLP can cause impairment of feeding,
hearing, nasal breathing, speech, dentofacial
growth and development, facial appearance
and psycosocial well being
• The goal of cleft care is to correct all the
problems attributable either directly or
indirectly to the original malformation.

• The burden of prolonged treatment -which

often extends over many years and involves
multiple surgical procedures - can cause
significant Disturbance in family life
• Early management - airway and feeding
• Parents of a child born with cleft lip and palate
need psychological support and access to early
specialist feeding advice.

• Babies with cleft lip or cleft lip and palate can

experience feeding problems that usually resolve in
the early neonatal period
• Babies with an isolated cleft palate may continue
to experience problems for many months and
require careful management.
• Babies with addi­tional anomalies are at increased
risk of feeding problems and may also have difficulty
maintaining a satisfactory airway.
• Mild cases can be managed conservatively by
careful postural management during feeding and
sleep.
• More severe cases may require airway support
during the early months of life with a
nasopharyngeal tube