General Surgery
Cleft Lip and Palate
MBBS surgery notes on cleft lip and palate: embryology, types, feeding and speech problems and timing of repair, mapped to NMC codes SU19.1 and SU19.2.
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Cleft Lip and Palate
MBBS surgery notes on cleft lip and palate: embryology, types, feeding and speech problems and timing of repair, mapped to NMC codes SU19.1 and SU19.2.
This chapter covers the embryology, presentation and staged management of cleft lip and palate. It highlights the feeding and speech consequences, the timing of repair and the multidisciplinary approach these children need.
High-yield: Cleft Lip and Palate
- Cleft lip and palate are among the commonest congenital anomalies and arise from failure of fusion of facial processes in early development.
- Cleft lip results from failure of fusion of the maxillary and medial nasal processes; cleft palate from failure of fusion of the palatal shelves.
- Clefts may be unilateral or bilateral, and complete or incomplete, and the lip and palate can be affected together or separately.
- A cleft lip is more common in boys, while an isolated cleft palate is more common in girls.
- Risk factors include a family history, maternal smoking, anticonvulsant use and folate deficiency in pregnancy.
- The main early problems are feeding difficulty, nasal regurgitation and later speech and hearing problems.
- Feeding is helped with special teats and upright positioning, since these infants struggle to generate suction.
- A widely used guide for timing lip repair is the rule of ten: about ten weeks of age, ten pounds in weight and haemoglobin of ten grams.
- Cleft lip is usually repaired around three months and cleft palate around six to twelve months of age.
- Early palate repair aims to protect normal speech development before the child starts to talk.
- Recurrent middle ear effusion and hearing loss are common because the cleft impairs Eustachian tube function.
- Care is best delivered by a multidisciplinary team including surgeon, orthodontist, speech therapist and audiologist.
- Velopharyngeal insufficiency after repair causes hypernasal speech and may need secondary surgery.
- A submucous cleft palate has a bifid uvula and a midline furrow but intact overlying mucosa.
- Long-term follow-up addresses dental alignment, speech, hearing and the psychosocial effect on the child and family.
Cleft lip versus cleft palate
- **Cleft lip:** Failure of fusion of maxillary and medial nasal processes; commoner in boys; repaired around 3 months.
- **Cleft palate:** Failure of fusion of palatal shelves; isolated form commoner in girls; repaired around 6 to 12 months.
- **Rule of ten:** A guide for lip repair: about 10 weeks old, 10 pounds weight and haemoglobin of 10 grams.
- **Key problems:** Feeding difficulty, nasal regurgitation, speech problems and recurrent middle ear disease with hearing loss.
NMC competencies in this chapter
- **SU19.1:** Embryology, types and clinical features of cleft lip and palate
- **SU19.2:** Principles and timing of management of cleft lip and palate
Frequently Asked Questions
How do cleft lip and cleft palate arise?
Cleft lip is failure of fusion of the maxillary and medial nasal processes, and cleft palate is failure of fusion of the palatal shelves during early facial development.
What is the rule of ten?
A practical guide for timing cleft lip repair: about ten weeks of age, a weight of ten pounds and a haemoglobin of ten grams, which indicates the infant is fit for surgery.
Why do these children get recurrent ear infections?
The cleft impairs Eustachian tube function, leading to middle ear effusion, recurrent otitis media and conductive hearing loss that can affect speech development.
Why is a multidisciplinary team needed?
Care spans surgery, feeding, orthodontics, speech therapy, hearing and psychosocial support, so a coordinated team gives the best functional and developmental outcomes.
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