← Case library
OMFS-0138ReconstructionadvancedLip, alveolus and palate

Newborn with a unilateral complete cleft lip and palate

0-year-old female

Draft — educational study aid, pending faculty review.

§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)

Fig. 1cleft lip and palate left seen from bottom

“Cleft lip max palate left bot” · Schwing · CC BY-SA 3.0 · Wikimedia Commons

Fig. 2cleft lip and palate both sides seen from bottom

“Cleft lip max palate left right bot” · Schwing · CC BY-SA 3.0 · Wikimedia Commons

Verified open-access images only, reproduced for education under their stated licences · no AI-generated or illustrative artwork · Cleft Lip and Palate figures pending faculty review.

§Differential diagnosis

Non-syndromic unilateral complete cleft lip and palateIsolated defect, no other anomalies
Van der Woude syndromeLower lip pits, autosomal dominant
Pierre Robin sequenceMicrognathia, glossoptosis, U-shaped cleft palate, airway obstruction
Median cleftMidline defect, associated with holoprosencephaly

§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.

§References

  • Royal College of Surgeons / national cleft care standards; Millard DR. Cleft Craft.

§Similar cases

OMFS-0137

Class III skeletal deformity with anterior crossbite

OMFS-0136

Single tooth implant replacement in the aesthetic zone

OMFS-0103

Painless mandibular expansion with tooth displacement

41 cases in the library