Newborn with a unilateral complete cleft lip and palate

§Chief complaint

Baby born with a split lip and palate, difficulty feeding

§Medical & dental history

• 01Term delivery, birth weight 3.1 kg
• 02No syndromic features; no maternal folate deficiency documented
• 03Neonate, no teeth erupted

§Clinical examination

• 01Complete left unilateral cleft of the lip, alveolus and primary and secondary palate
• 02Deviated columella and flattened left nasal ala
• 03Poor suction with inability to establish a seal at the breast
• 04Ears, hands and heart examination normal; no micrognathia

§ figuresFigures (3)

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§Differential diagnosis

§Final diagnosis

Non-syndromic complete left unilateral cleft lip and palate

The absence of lower lip pits, micrognathia, airway obstruction or other congenital anomalies points to a non-syndromic cleft. Screening for syndromic associations changes the whole care pathway, so it is done first.

§Investigations

• 01Full neonatal examination and paediatric review with hearing screen
• 02Genetic assessment and counselling for the family
• 03Feeding assessment by the cleft specialist nurse
• 04Serial photographic and impression records

§Treatment plan

• 01Immediate: feeding support with specialised bottles and teats, weight monitoring
• 023 months: cheiloplasty (Millard rotation-advancement) with primary nose correction
• 039-12 months: palatoplasty for speech
• 04Speech and language therapy, audiology, orthodontics through childhood
• 059-11 years: alveolar bone grafting timed to canine root development
• 06Skeletal maturity: orthognathic surgery and rhinoplasty if needed

§Surgical procedure

• 01Cheiloplasty at 3.5 months using rotation-advancement with primary rhinoplasty
• 02Palatoplasty at 10 months with intravelar veloplasty

§Follow-up & outcome

• 01Speech assessed as age-appropriate at 5 years with no velopharyngeal insufficiency
• 02Secondary alveolar bone graft at age 9 with iliac crest cancellous bone; canine erupted through the graft
• 03Orthodontic alignment in progress

§Clinical pearls / learning points

• 01Cleft care is a lifelong multidisciplinary pathway, not a single operation.
• 02Alveolar bone grafting is timed to canine root development (two thirds formed), not to chronological age.
• 03Always examine the lower lip for pits — Van der Woude is the commonest syndromic cleft.

§Related diseases

§Similar cases