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.

Only gold members can continue reading. Log In or Register to continue

Stay updated, free articles. Join our Telegram channel

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

Full access? Get Clinical Tree

Get Clinical Tree app for offline access