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


    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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