SU19.1-2 | Cleft Lip and Palate — Summary & Reflection

KEY TAKEAWAYS

Cleft lip and palate is the commonest congenital facial anomaly (~1 in 700-1000) and arises from a failure of embryological fusion: the lip and primary palate (anterior to the incisive foramen) form from the medial nasal and maxillary processes, while the secondary palate (posterior to the incisive foramen) forms from the palatal shelves. Clefts are classified by site (lip, palate, or both), laterality (unilateral — often left — vs bilateral) and completeness (incomplete vs complete); aetiology is usually non-syndromic and multifactorial, sometimes syndromic (e.g. Pierre Robin sequence). Presentation centres on feeding difficulty, later otitis media/hearing loss, hypernasal speech and psychosocial impact. Care is multidisciplinary — first secure airway and feeding, then a team manages surgery, hearing, speech and dentition. Reconstruction is staged by the rule of 10s (~10 weeks, ~10 lb, Hb ~10 g/dL): lip repair at ~3 months (Millard rotation-advancement) and palate repair at ~6-12 months before connected speech (palatoplasty reconstructing the muscle sling), followed by alveolar bone grafting (~8-11 years) and secondary speech, orthodontic and nasal procedures.

REFLECT

Imagine you are the doctor counselling the mother of the newborn in the hook on his second day of life. How would you explain, in plain language, what has happened embryologically and reassure her that there is a clear, well-trodden plan — feeding support now, lip repair at around three months, palate repair before he learns to talk? Reflect on how you would prioritise feeding and airway before ever mentioning the operation, and how you would set realistic expectations about the years of multidisciplinary care to come. Consider, too, how knowing the rule of 10s and the reasons behind the timing changes the way you would consent the family for each stage of surgery.