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Cleft lip with or without cleft palate is the most common congenital malformation of the head and neck.
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Each patient should be evaluated for congenital anomalies, developmental delay, neurologic disorders, and psychosocial concerns before surgery.
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A multidisciplinary team is necessary to ensure that every aspect of the child’s care is treated.
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The surgeon should be aware of the needs of the cleft patient and be able to educate and assist caretakers as necessary.
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A fundamental understanding by the
Cleft Lip and Palate
Section snippets
Key points
Overview
Cleft lip with or without cleft palate is the most common congenital malformation of the head and neck. The impact on quality of life for the child and the family can be severe, particularly in unsuspecting families. Emotional and psychological needs must be recognized and addressed, in addition to surgical care, for all those involved with the patient. Assessment and treatment of those with cleft lip and/or palate requires a multidisciplinary approach. Access to and evaluation by
Multidisciplinary Care
Patients with cleft lip and/or palate may present as early as during the prenatal period. Surgical consultation before birth is becoming more common because of the ability to make the diagnosis on prenatal ultrasonography. Discussion regarding general care issues and surgery can help improve some of the anxiety the expecting mother may be experiencing. After birth, the initial management includes ensuring proper feeding of the neonate and evaluation for other comorbidities. As previously
Preoperative Planning and Preparation
Before surgical treatment of a unilateral cleft lip, adequate weight should be established, with the child weighing at least 4.5 kg (10 lb). Breast feeding is recommended, when possible, but often this is difficult for the infant. However, pumped breast milk may be taken via bottle feeds with the use of a specialized nipple that controls the flow rate, such as a Haberman or pigeon-type nipple based on an evaluation by speech therapy. Most surgeons prefer an average of 28 g (1 ounce) of weight
Preoperative Planning and Preparation
The preoperative evaluation and management in patients with a bilateral cleft lip is similar to those in patients with a unilateral malformation. There are different formations of bilateral cleft lip that may affect the position of the premaxilla, such as complete, incomplete, and microform deformities (which may occur in variations on either side of a cleft). As with patients with unilateral cleft lip, the child and the caretakers should be seen in clinic as soon as possible after the birth.
Preoperative Planning and Preparation
Repair of the cleft palate focuses on the separation of the nasal and the velopharyngeal mechanisms. This repair can determine the outcomes of the child’s speech, feeding, and eustachian tube function, and may affect the maxillary growth and dental arch relationship.35, 36 The preoperative evaluation is the same as for a child with only a cleft lip; however, particular attention is paid to ensuring that the caretakers understand proper methods for feeding and caring for the child. Monitoring
Summary
Orofacial clefting significantly affects the quality of life of the child involved. The American Cleft Palate – Craniofacial Association recommends a team approach in the management of these patients. Associated congenital anomalies, developmental delay, neurologic disorders, and psychosocial needs should be identified and treated appropriately. A multidisciplinary team can be helpful in ensuring that the child undergoes proper specialty evaluations and in determining the most suitable
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