Cleft Lip and Palate Guidelines
|Reviewed by Guidelines Committee|
|Incidence||Immediate Management||Feeding Guidelines|
|Timing of Surgery||Other Issues||Followup|
Clefts can range with varying degrees of complexity from incomplete cleft lip
to complete bilateral cleft lip and palate
A type of cleft which is often missed is a submucous cleft palate. The signs to look for are – bifid uvula, transparent line down soft palate, presence of notch at junction of hard and soft palate.
As well as being fundamental to ‘normal’ facial appearance, the structures
involved in cleft lip and/or palate repair are vitally important to the
development of normal speech, feeding and dentition.
A cleft lip and/or palate has tremendous aesthetic and functional implications for the patients in their social interactions therefore the multidisciplinary team need to take into account, not only the anatomical impairment of the cleft, but the potential impact of the cleft on the patient's ability to communicate effectively, and their facial appearance.
The overall aims in treating cleft lip and palate are:
Pierre Robin Sequence PRS
Consider Velocardiofacial Syndrome also known as Chromosome 22q11 syndrome as this is the most common syndrome associated with cleft palate
The Cleft nurse coordinator will visit the newborn infant within 24-48 hours of birth and will arrange appropriate followup. 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:
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.