Incidence

• Bifid uvula 2%. This may indicate underlying submucous cleft.
• 1:800-1,000 cleft lip and palate.
• 1:2,000 isolated cleft palate.

Immediate Management

1. Paediatric assessment (SHO, NS-ANP, Registrar, or Consultant). In particular examination for other abnormalities, airway and breathing difficulties.
2. Paediatric staff will refer to the Middlemore Hospital Plastics Team Clinic.
   • Fax: 276 0004
     Referral will be acknowledged by Clinic Manager by return fax Monday to Friday
   • Plastic Surgical Registrar can be contacted after hours or on the weekend if urgent acknowledgement is required.
3. Referral to the Lactation Consultant, National Women’s Hospital.
4. Referral to the Speech Language Therapist, Middlemore Hospital
   • Phone 263 0792  Ext.3245
   • Locator 93 8155
   • Plus written referral by fax 263 0539 to SLT.
5. Cleft Lip and Palate Support:  The information pack is the Blue Book which is available on NICU and is given to and discussed with the parents (available from the Cleft Lip & Palate Support Group and available online (downloadable in Adobe Acrobat format)).  A visit can be arranged if parents request via the email address in the Blue Book.

Feeding Guidelines

• Click here to open the Feeding Guidelines

Timing of Surgery

Surgical priorities are:

Other Issues

• Children with Pierre Robin Syndrome or severe micrognathia are at high risk of airway obstruction and may need to be nursed prone so that the tongue falls forward and they may need tube feeding and saturation monitoring. The relative mandibular under-development and glossoptosis usually disappears by early teens.
• Cleft lip and palate may be part of dysmorphic syndromes. Up to 40% will have associated malformations. Investigations may include:
  • A detailed family history is important.
  • Chromosomes.
  • Consider velocardiofacial syndrome, chromosome 22q syndrome or Di George Syndrome – cytogenetics.
  • Ultrasound scans of head, heart and kidneys. Radiographs of spine.
  • Referral to the Geneticist for counselling.

Follow Up

The Middlemore Hospital Cleft Lip and Palate Team Plastic Surgeon and Speech-Language Therapist try to see the newborn baby within a few days after birth. The team will then assess the child in clinic within 6 weeks.  The surgeon will outline and individualise management for that child.  The team includes:

• Plastic surgeon
• Orthodontist
• Speech-Language Therapist
• Plastic Surgery Nurse
• ENT Surgeon

If other anomalies are present then the Specialist will need to follow up as appropriate, e.g. Paediatric Cardiology at Starship Hospital. A National Women’s newborn service appointment may be offered for three months to ensure that all is progressing normally in terms of follow up arrangements, feeding, growth and early development.

Parents are not always aware that the management of cleft lip and palate is long term and follow up may be into the child’s twenties before orthodontics is completed. Rhinoplasty, jaw and further lip surgery may also need to be scheduled at this late stage. We should endeavour to inform the parents with the help of literature that the immediate repair is only the beginning of a long term relationship with the Plastic Surgical Team.