This document discusses cleft lip and palate, including statistics on prevalence and associations. It notes that cleft lip and palate can be caused by both genetic and environmental factors. It then describes various surgical techniques for repairing cleft lip, cleft palate, and submucous cleft palate. Post-operative care is also outlined. The goal of surgery is to achieve normal speech outcomes while allowing for maxillary growth.

1. Dr. Moeez Fatima

3.  cleft lip and palate (46%)
 isolated cleft palate (33%) and
 isolated cleft lip (21 %).
 The majority of bilateral cleft lips (86%) and unilateral
cleft lips (68%) are associated with a cleft palate.
 Unilateral clefts > bilateral clefts (x 9)
 Left side > right.
 Males > Female
 Isolated cleft palate occurs more commonly in
females.

4.  Both environmental teratogens and genetic
factors are implicated in the genesis of cleft lip
and palate.
 Lntra-uterine exposure to the anticonvulsant
phenytoin is associated with a 10-fold increase in
the incidence of cleft lip.
 Maternal smoking
 Alcohol, anticonvulsants, and retinoic acid.
 > 40% of isolated cleft palates are part of
malformation syndromes, compared with less
than 15% of cleft lip and palate cases

24.  Straight line repair
 Rotation-advancement

26.  Advantages: Simple, speedy
 Disadvantages: Asymmetric cupid’s bow,
Prominent scar, Retrusion of maxilla.

28.  Salyer's modification: Salyer modified the
rotation advancement with many
improvements, most notably by making the
transverse incision of the lateral segment
B‐flap not below the alar rim, but instead
intranasally.

35.  Incomplete cleft palate / Isolated cleft palate.
 Incidence: 0.5 : 1000
 Variable: from an opening in the posterior
soft palate to a cleft extending up to the
incisive foramen.
 Strongly associated with Pierre Robin
sequence.

38.  Incidence- 1:1200 live births
 Palate has mucosal continuity but the underlying
levator palatini muscle is discontinuous across the
midline and longitudinally oriented.
 Calnan’s classic triad:
 Midline clear zone (zona pellucida)
 Bifid uvula
 Palpable notch in the posterior hard palate
 Repair of the abnormal levator muscle position.
 The Furlow double opposing Z-plasty is an ideal
procedure.

39.  Pierre Robin sequence
 Van derWoude syndrome
 22q chromosomal deletion
 Stickler’s syndrome

40.  SpeechV/S Maxillary growth.
 Palate repair in the syndromic patient.
(a)Two-stage repair: with the soft palate repair and
veloplasty performed at the time of lip adhesion or
primary lip repair, and the hard palate repaired before 18
months, or delayed further with the use of an obturator.
(b) single-stage repair around the age of 11 to 12 months.
Our center practices the latter approach, delaying the
surgery until the time when the child starts to
demonstrate the introduction of plosives (b, d, and g) in
their speech.

41.  Two-flap palatoplasty with intravelar
veloplasty as a modification of the technique
described byVeau,Wardill, and Kilner (the
"Oxford" palatoplasty), or
 a single-stage two-flap palatoplasty with
Furlow double-opposing z-plasty to achieve
the levator repositioning and lengthening of
the palate.

49.  Breathing:
 Continuous pulse oximetry.
 minimizing narcotic use.
 Pain management:
 Acetaminophen 15 mg/kg
 ibuprofen 10 mg/kg.
 Bleeding:
 reduced by surgery that takes less than 90–120 min.
 Light pressure on the hard palate repair at the conclusion of the
procedure
 application of ice packs to the posterior neck

50.  Feeding:
 liquids for 10–14 days
 parents must learn to time feeding 30 min or
so after analgesic administration.
 Arm splints

51.  Fistula
 Speech outcomes/VPI
 Maxillary growth

52.  Normal speech is the primary goal of cleft palate
repair.
 Cleft palate repair prior to 1 year of age (ideally 9–10
months) results in better speech outcomes than later
repairs.
 The levator veli palatini muscle realignment of the
muscle is key to a successful functional result.
 Eustachian tube function is abnormal in cleft patients
due to abnormal position of the tensor veli palatini
muscle.