AtlasDevelopmentalCleft Lip and Palate

Developmental Disorders

Cleft Lip and Palate

aka CLP · Orofacial Cleft · Cheiloschisis (lip) · Palatoschisis (palate)

Congenital defect from failure of fusion of facial processes resulting in cleft lip, palate, or both.

Lip repair
10 weeks (Rule of 10)
Palate repair
9-12 months
Alveolar bone graft
9-11 years

§ overviewOverview

Non-syndromic or syndromic oro-facial cleft due to incomplete fusion of maxillary and medial nasal processes (lip) or palatal shelves (palate) during embryogenesis.

§ icdICD Classification

Q35-Q37

§ etiologyEtiology

  • 01Multifactorial (genetic + environmental)
  • 02Genes: IRF6, MSX1, TGFβ3
  • 03Teratogens: alcohol, smoking, anticonvulsants

§ riskRisk Factors

  • 01Family history
  • 02Maternal smoking/alcohol
  • 03Folate deficiency
  • 04Anticonvulsant use

§ epidemiologyEpidemiology

CL ± P: 1:700 (Asians) to 1:1000 (Caucasians). Isolated CP: 1:2500. Male > female for CL ± P; female > male for isolated CP.

§ pathogenesisPathogenesis

Failure of fusion between 4–12 weeks IU. Lip closes week 6; palate closes weeks 7–12.

§ clinicalClinical Features

  • 01Unilateral or bilateral cleft lip ± alveolus
  • 02Cleft of hard/soft palate
  • 03Nasal deformity
  • 04Feeding difficulties
  • 05Speech problems (VPI)
  • 06Dental anomalies (missing/supernumerary teeth)

§ investigationsInvestigations

  • 01Antenatal USG (lip visible 18 wks)
  • 02Genetic testing for syndromic cases
  • 03Speech/hearing assessment

§ classificationClassification

  • 01Veau classification (I-IV)
  • 02Kernahan striped-Y
  • 03Tessier classification (craniofacial clefts)

§ treatmentTreatment

  • 01Multidisciplinary cleft team
  • 02Lip repair: 10 weeks (rule of 10s)
  • 03Palate repair: 9–12 months
  • 04Alveolar bone graft: 9–11 years (mixed dentition)
  • 05Secondary rhinoplasty, orthognathic surgery as needed

§ surgicalSurgical Management

  • 01Millard rotation-advancement (lip)
  • 02Furlow double-opposing Z-plasty (palate)
  • 03Alveolar bone grafting (iliac crest)

§ complicationsComplications

  • 01VPI and hypernasality
  • 02Eustachian tube dysfunction → OME/hearing loss
  • 03Maxillary hypoplasia
  • 04Dental anomalies

§ prognosisPrognosis

Excellent aesthetic and functional outcomes with early comprehensive care.

§ examKey Examination Points

  • 01Rule of 10 for lip repair
  • 02VPI = velopharyngeal insufficiency
  • 03Alveolar bone graft timing: mixed dentition

§ revisionQuick Revision Summary

  • 01CL+P: male > female
  • 02Isolated CP: female > male
  • 03IRF6 gene — Van der Woude syndrome

§ vivaBDS Viva Questions

  • 01When is cleft lip repair performed?
  • 02What is Veau classification?
  • 03Describe the embryology of cleft palate.

§ mcqsMCQs — Assessment (3)

Question 1

Ideal timing for cleft lip repair:

Question 2

Most common cleft type:

Question 3

IRF6 mutation is associated with:

References

  1. Mossey PA. Lancet 2009;374:1773
  2. Neville BW. Oral & Maxillofacial Pathology, 4e

Draft — pending faculty review. Educational use only; verify against current guidelines and primary sources before clinical application.