Cleft Lip and Palate

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Cleft Lip and Palate

Cleft lip and palate (CLP) are among the most common craniofacial abnormalities, and even the most common congenital defects.

They occur in isolation, or in association with other congenital and craniofacial abnormalities.

It is estimated that 6 in 10,000 live births are born with an isolated cleft palate, and around 10 in 10,000 are born with a cleft lip, either isolated or associated with a cleft palate

  • Overall incidence of cleft lip and palate is approximately 1 in 600 to 800 live births (1.42 in 1000) and isolated cleft palate occurs approximately in 1 in 2000 live births. Thus, the typical distribution of cleft types are:
  • Cleft lip alone – 15%
  • Cleft lip and palate – 45%
  • Isolated cleft palate – 40%.
  • Unilateral clefts are more common than bilateral clefts with a ratio of 4:1


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  • Genetic:



  • Non Genetic

– Smoking

– Alcohol Use

– Environmental Factors

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Pre-Surgical Treatment


Latham Device

Naso-Alveolar Moulding:

Nasal Stent

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Goals Of Repair:

  • Symmetry of Cupid’s bow in relation to the lip, with the two high points being equidistant from the low point.
  • Symmetry of Cupid’s bow in relation to the nose, with matching of the two high points in relation to the nostril base.
  • Continuity of the orbicularis oris muscle: The muscle fibers should flow smoothly throughout the upper lip without any residual deficiency or notching.
  • Symmetry of the philtral ridges and adequate fullness of the philtral tubercle.
  • Symmetry of the nasal domes.
  • Adequate nasal tip support and projection.
  • Symmetric out-flaring of the medial crural footplates.
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Timing Of Repair

Millard’s rule of 10’s

-Haemoglobin 10 g/dL,

-Weight 10 lbs,

-10 weeks of age

-WBC count of no more than 10000

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Unilateral Cleft Lip:

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Bilateral cleft lip:

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Postoperative Wound Care

  1. Sterile strips are applied after an adhesive application to reduce the tension placed on the closure

     2.Suture area should be cleaned daily with saline and baby soap twice; topical application of antibiotics is recommended for 10            days.

  1. 3 weeks post-op, we recommend to massage the scar towards the mucosa to prevent scar contracture.
  2. Massage can be done with vitamin E cream/silicone gel/ oil. It is recommended to massage for at least 6 months.
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  1. Wound Infection
  2. Dehiscence
  3. Lip Scar
  4. Vertical Excess/ Deficiency
  5. Orbicularis Oris Abnormalities
  6. Whistle Deformity
  7. Buccal Sulcus and Vermilion border deficiency
  8. Notching
  9. Horizontal deficiency
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  1. Very challenging
  2. Intra oral negative pressure
  3. Malnutrition
  4. High risk of aspiration
  5. Recurrent aspiration resulting in respiratory infections including sinusitis, pneumonia, and even death.
  1. Basic steps in palate repair

    • Undermining of the mucoperiosteal flaps on the oral side
    • Dissection of the neurovascular bundle
    • Dissection of the mucoperiosteum on the nasal side
    • Dissection of the muscles of the soft palate from the

    –posterior edges of the hard palate

    –And the nasal mucoperiosteum

    • Closure of nasal layer
    • Creation of muscle sling
    • Closure of oral layer
    • Postoperative feeding

    –Postoperative oral fluid

    –Early oral feeding pacifies the child, who then sleeps well.

    • Postoperative analgesia

    –The use of the nonsteroidal anti-inflammatory drug, diclofenac, in the form of rectal suppository provides effective analgesia.

    • Postoperative arm restraint

    Arm restraints are used to avoid self-inflicted trauma with uncontrolled hand movement of the child during postoperative period

    • Pts are usually discharged 2-4 days after surgery on semisolid diet.
    • This diet is continued for 3 weeks till pts return to normal diet and after discharge pts seen at 10 days follow up.
    • Within 3 -6 months of complete closure of the palate patients encouraged for sucking and blowing games.


  1. Complications

    • Immediate


    –Respiratory obstruction

    –Hanging Palate

    –Dehiscence of the repair

    –Oronasal fistula formation

    • Late

    –Bifid uvula

    –Velopharyngeal Incompetence

    –Maxillary hypoplasia

    –Dental malpositioning and malalignment


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