Cleft lip & Cleft palate

History :

• H/O gap in lip or palate. 
•  H/O maternal drug exposure. 
  
• F/H same disease: so careful 
• examination of parent (5O%case). O May associate with syndrome. 
  
• H/O feeding problem. 
• H/O repeated ear infection 
• H/O repeated respiratory tract infection. 

O/E:

• Variable notch in lip to complete separation. 
• Unilateral / bilateral 
• Separation of palate (soft, hard, uvula). 
• ENT : Otitis media
• Lungs-crepitationpneumonia
• Associated anomaly: CHD. 

Investigation: . 

Clinical diagnosis. Investigation needs to see complication and association.

• 1. X-ray mastoid town’s view : To see otitis media.
• 2. CXR : If suspected pneumonia.
• 3. Echo : To detect associated cardiac anomalies. 

Rx:

• Multidisciplinary team is needed 
• Counseling about disease Counseling about feeding nature, treatment option, and prognosis.
• Counseling about Feeding:
• Feeding up-right position.
• Usesoft artificial nipple & large opening with a squeezable bottle.
• Use a plastic obturator to assist in feedine. 
• Supportive : Maintain nutrition .
• Specific treatment :
• Modified millard-rotation : advanchment technique 
• There is a general role of surgery.
• Cleft lip : 10 wks age — 10 gm Hb — 10 Ib wt
• Cleft palate—10month 10 gm Hb - 10kg wt. 
• Treatment of complication : 
• Repeated otitis media 
• Recurrent respiratory tract infection
• Speech problem Treated accordingly.
• Hearing problem
• Malocclusion of teeth.
• Follow -up
  
• Prognosis :
• Prevention: