Case 17 Cleft Palate



Vinay Rao and Albert S. Woo

Case 17 Cleft Palate

Case 17 A 5-year-old boy with concerns over hypernasal speech.



17.1 Description




  • Photo reveals a submucous cleft palate




    • Bifid uvula



    • Zona pellucida: Diastasis of levator muscle with notable thinning of soft tissue at the midline, especially with elevation of the palate



    • Patient is phonating with anterior displacement of levator muscles (inverted V)



17.2 Work-Up



17.2.1 History




  • Pregnancy, birth, and newborn history




    • Prenatal care and exposures (alcohol, smoking, anticonvulsants, corticosteroids)



    • Gestational age of the newborn at birth (e.g., preterm, term, and postterm)



  • Family history of orofacial clefting



  • Additional medical problems




    • Cleft palate without cleft lip: 40% incidence of syndromic presentation



  • Airway concerns




    • Consider Pierre Robin sequence (Chapter 18) if small jaw and airway obstruction



  • Feeding and weight gain history



17.2.2 Physical Examination




  • Classify the extent of cleft and structural involvement




    • Complete (i.e., soft and hard palates) or incomplete (i.e., soft palate alone)



    • Primary and/or secondary palate (dividing point is the incisive foramen)



    • Unilateral or bilateral (vomer visible on one or both sides)



    • Cleft lip involvement, if any



    • Veau cleft palate classification system (Table 17.1)



  • Evaluate for facial dysmorphic features and other congenital anomalies




    • Cleft palate alone (without cleft lip): 40% incidence of syndromic presentation



    • Mandible evaluation: Pierre Robin sequence—micrognathia/retrognathia, glossoptosis, and airway difficulties (see Chapter 18)



  • Head-to-toe examination for other anatomic abnormalities























    Table 17.1 Veau cleft classification system

    Veau classification system


    Description


    Veau I


    Incomplete cleft of the palate:


    Cleft of the soft palate only


    Veau II


    Complete cleft of the secondary palate:


    Cleft of soft and hard palates


    Veau III


    Unilateral cleft lip and palate


    Veau IV


    Bilateral cleft lip and palate




17.2.3 Pertinent Imaging or Diagnostic Studies




  • Evaluate other organ systems (e.g., echocardiogram, renal ultrasound, X-rays of the spine) if there is suspicion for other congenital anomalies or syndrome.



  • Perform genetic testing if syndrome is suspected, possible through chromosomal microarray analysis.

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Jul 17, 2021 | Posted by in General Surgery | Comments Off on Case 17 Cleft Palate
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