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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