Bilateral Cleft Lip
Description
Complete bilateral cleft lip deformity
Notable projection of the premaxilla with good symmetry.
Cleft nasal deformity: Widened nostrils bilaterally with short columella.
Bilateral alveolar cleft deformity with pronounced gap between segments.
Likely complete bilateral cleft palate (not completely visualized).
Work-up
History
Family history of orofacial clefting.
Feeding difficulties, appropriate weight gain.
Additional medical problems and associated syndromes.
Physical examination
The examination should focus on four features: Nose, lip, alveolus, and palate.
Cleft lip and palate classification
Unilateral versus bilateral.
Complete (involvement of nasal floor) versus incomplete.
Isolated cleft lip (primary palate) versus cleft lip and palate (primary and secondary palate).
Additional facial dysmorphic features.
Complete physical examination to look for any other anatomical abnormality
Consider possibility of syndromic presentation.
Pertinent imaging or diagnostic studies
Guided by physical findings (e.g., echocardiogram, renal ultrasound, skeletal X-rays).
Consultations
Children with clefts are ideally cared for by a multidisciplinary team: Plastic surgery, otolaryngology, speech pathology, audiology, child/developmental psychology, nursing, pediatric dentistry, orthodontics, and oral and maxillofacial surgery.
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