Otolaryngology: Oral Clefting

Embryology

• Defect of the Primary Palate
• Failure of Fusion of the Lateral Nasal, Median Nasal or Maxillary Mesodermal Processes
• Types:
  • Incomplete – Involves Only the Upper Lip
  • Complete – Involves the Upper Lip & Nose
• Often Occurs Simultaneously with Cleft Palate (CL/P)

Sites

• Unilateral (Most Common)
• Bilateral (Less Common)
• Median (Rare)

Diagnosis

• Assessed by Standard Prenatal Ultrasound After 13-14 Weeks
• Readily Diagnosed by Physical Exam After Delivery if No Prenatal Care Was Obtained

Newborn Management

• Naso-Alveolar Molding (NAM) with Orthodontic Appliance to Mold into a More Favorable Position for Later Reconstruction
• Less Likely to Require Special Devices to Feed (Compared to Cleft Palate)

Surgical Repair

• Timing:
  • Generally Done Between 3-5 Months of Age
  • Deciding Timing for Safe Repair: Musgrave’s “Rule of 10’s” Mn
    • Age > 10 Weeks
    • Weight > 10 lbs.
    • Hemoglobin > 10 mg/dL
  • Done Before Cleft Palate if Concomitant
• Repairs:
  • Unilateral: Millard Rotation-Advancement Repair, Fisher Repair or Mohler Repair
  • Bilateral: Mulliken Repair
• If Involves Hard Palate Anterior to Incisive Foramen: Delay Until Age 1 Year
  • Allow Maxillofacial Growth