Case 16 Bilateral Cleft Lip Deformity

Vinay Rao and Albert S. Woo

Case 16 Bilateral Cleft Lip Deformity

Case 16 (a, b) A 12-day-old infant boy born with a cleft lip.

16.1 Description

  • Bilateral cleft lip deformity

    • Left side is complete, right incomplete with presence of Simonart’s band

    • Flattening of nasal tip and widening of nose with shortened columella

    • Nostrils are asymmetric and wider on left side due to complete cleft

  • Left alveolar cleft deformity with gap noted between segments

  • Palate is not visualized

16.2 Work-Up

16.2.1 History

  • Family history of orofacialclefting

  • Evidence of feeding difficulties, appropriate weight gain

  • Monitor for appropriate weight gain

  • Additional medical problems and associated syndromes

16.2.2 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 palates)

  • Additional facial dysmorphic features

    • Lower lip pits: Van der Woude syndrome (autosomal dominant)

  • Complete physical examination to look for any other anatomic abnormality

    • Consider possibility of syndromic presentation

16.2.3 Pertinent Imaging or Diagnostic Studies

  • Echocardiogram, renal ultrasound, skeletal X- rays, etc., depending on physical findings

16.2.4 Consultations

  • Children with clefts are ideally cared for by multidisciplinary team: Plastic surgery, otolaryngology, speech pathology, audiology, child/developmental psychology, nursing, pediatric dentistry, orthodontics, and oral and maxillofacial surgery.

16.3 Treatment

  • Management via multidisciplinary team

  • Schedule of treatment (see Table 15.1 for cleft management timeline)

16.3.1 Feeding: Critical Aspect of Cleft Care

  • Specialized nipples/bottles: Dr. Brown bottle, Haberman nipple (with a squeezable tip) or Pigeon nipple (with crosscut opening for faster flow)

  • General principle is to hold infant at 45 degrees and drip formula into the mouth and allow the infant to swallow.

  • Babies with cleft palate cannot create adequate suction on a bottle or breast.

  • Weight gain: After the first 2 weeks of life, the child should gain half a pound every week

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Jul 17, 2021 | Posted by in General Surgery | Comments Off on Case 16 Bilateral Cleft Lip Deformity
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