Cleft Lip & Palate

Cleft Lip = hypoplasia of mesenchymal layer, failure of medial nasal and maxillary processes to join.

Cleft Palate = failure of palatal shelves to approximate/fuse

Epidemiology
Cleft Lip
- w/wo cleft palate = 1/750
- males
- maternal drug exposure, syndrome-malformation complex, genetic
- sporadic
Cleft Palate alone = 1/2500

- Van der Woude syndrome - either or both inherited in a dominant fashion -recurrence 50%
- highest in Asians, lowest in Blacks

Cleft palate alone - increased incidence of associated congenital defects
- conductive hearing impairment in children (repeat OM)
- chrosomal abN

Clinical Manifestations
Cleft Lip
- vary from small notch in vermilion border to complete separation extending to floor of nose
- unilateral (more often on left side)
- bilateral
- may involve alveolar ridge
- a/w deformed, supernumerary pr absent teeth
Isolated cleft palate
- midline
- may involve only the uvula or extend into/thru soft and hard palates to the incisive foramen
- when a/w cleft lip - involve midline of soft palate and extend into hard palate on both sides = unilateral or bilateral cleft palate

Treatment
1) Feeding
2) Sx closure of Cleft Lip S/P 3/12 - satisfactory wt gain, free of oral, resp or systemic infx
- Z-plasty
3) Rehab
4) Orthodontist

Sequelae
- recurrent OM
- hearing loss
- displacement of maxillary arches
- malposition of teeth
- speech defects