Cleft lip and palate

Question 1

Definition of cleft lip/palate

Answer 1

Facial clefts are deformations of the face caused by relative tissue deficits along linear
anatomical planes.

Question 2

Differentials

Answer 2

- Normal Philtrum
• Amniotic bands
• Facial mass
• Teratoma
• Frontal encephalocele
• Hemangioma
• Holoprosencephaly
• Trisomy 13/18
• Syndrome (over 300 with facial cleft as part)

Question 3

Epidemiology of cleft lip

Answer 3

0. 15 % of live births
   * 80% of cleft lip has an associated cleft palate*

More common in asian ethnicity

30% syndromic (50% if isolated cleft palate)

Question 4

Classification of cleft lip/palate

Answer 4

Classification

Type I Unilateral cleft lip
Type II Unilateral cleft lip and palate
Type III Bilateral cleft lip and palate
Type IV Midline cleft lip and palate

Question 5

Medications that can cause cleft lip/palate

Answer 5

retinoic acid,
valproic acid,
hydantoin,
Methotrexate

Question 6

Other risk factors for cleft lip/palate

Answer 6

-Genetic factors
-Cigarette smoking
• Alcohol
• Folate deficiency
• Maternal obesity

Question 7

Detection rate

Answer 7

<30% detected antenatally

Question 8

Management if identified

Answer 8

• Detailed anatomy scan
• Offer amniocentesis- significant risk of aneuploidy
• Preparation for delivery
  a. Plastic surgeon, ENT, Dentist, speech and language therapist, social work, psychiatrist, genetic counsellor
• Surgery
  a. Repair of cleft lip at 2-3 months
  b. Repair of cleft palate at 9-18 months