Cleft Lip / Palate

Occurs in ~1:600 births. Since the lip and palate develop separately at different gestational times, a baby can have an isolated cleft lip, an isolated cleft palate, or both together.

History

Ask about feeding difficulties and speech.

Examination

Recognise the simplest, least obvious form in time for adequate repair — the submucous cleft is frequently missed in infancy because the palate looks intact on casual inspection. Look closely: a bifid uvula and a deep midline groove in the palate covered only by mucous membrane; also feel for an opening in the hard palate.

Cleft lip: an opening in the upper lip, may extend into the gum (alveolus); a complete cleft extends all the way into the nostril. Can be unilateral or bilateral, with or without an accompanying cleft palate.

Investigations

Antenatal diagnostic ultrasound of the palate.

Management

Refer to a maxillofacial/plastic surgeon.

• Cleft lip repair: typically age 3–6 months.
• Cleft palate repair: typically around 12 months.
• Feeding: babies often need specialist support — generating suction is difficult; specialist cleft bottles/teats are available.
• Hearing: commonly complicated by middle ear effusion — monitor hearing at 4 weeks and again around 3 months; ENT input for possible grommet insertion.
• Speech: often needs a specialist cleft speech pathologist, and may need further surgery as the child grows.
• Teeth: dental complications are common — early, regular dental review and (very commonly) orthodontic treatment.