Cleft lip is a congenital deformity condition where baby’s lips are not able to develop properly during pregnancy.
It is a physical split or separation in the upper lip. Cleft lip can occur on one/both sides of lip, and it ranges from small notch to large opening extending into nose.
Cleft lip forms in early pregnancy when lip tissues do not fuse properly. Inadequate fusion of lip and palate tissues during 4 to 7 weeks of pregnancy leads to cleft formation.
Various cleft lip deformities can occur with palate. The microform or occult cleft shows incomplete lip separation with distortion but no separation of vermillion border.
Complete cleft lip has total separation of lip and nasal sill, some patient may show unilateral/bilateral cleft type.
Epidemiology
Males have a higher incidence of left-sided cleft lips, with a 0.1% overall risk in the population.
Cleft lip is more prevalent in Asians, with a rate of 2 out of 1000 babies, compared to Caucasians and African Americans.
Cleft lip in children is linked to genetic factors and other congenital malformations up to 29%.
Malnutrition and exposure to phenytoin, steroids, tobacco, alcohol, and Accutane increase risk of cleft lip.Patient’s genetic make-up plays a major role in formation of cleft lip.
Anatomy
Pathophysiology
cleft lip patients have changes in anatomy. These include a short philtrum, affected philtral columns, and abnormal orbicularis oris.
Children will show consistent nasal abnormalities with a downward shifted nasal septum, detached anterior nasal spine, and rotated nasal cartilage.
Changes in facial structure affect speaking, eating, and appearance in patients.Cleft lip forms where lateral and central upper lip segments meet, that extend into maxilla and palate.
Etiology
Between 3 to 6 weeks gestation, nose and lip form from first and second pharyngeal arches, known as lateral nasal processes.
Use of phenytoin in pregnancy increases the risk up to 10 times.Prenatal smoking doubles the rate of cleft lip in newborns compared to non-smoking mothers.
Van der Woude syndrome is a well-known syndrome linked to clefts of lip and palate. It is an autosomal dominant disorder with distinctive features.
Clefts in secondary palate have higher syndrome association than clefts in lip/palate.
Genetics
Prognostic Factors
Unilateral clefts have better prognosis than bilateral clefts, which present more complexities in treatment.
Prognosis for only cleft lip is good, but more complicated with part of syndrome or other anomalies.
Intervention within months of birth improves function and appearance results.
Skill and experience of surgical team is crucial for prognosis. Quality repair reduces complications and additional surgeries.
Clinical History
Clinical history includes inquiry about prenatal history, family history, and maternal health.
In developmental history include information/progress of speech and hearing ability.
Physical Examination
Nose Examination
Ears Examination
Head and Face Examination
Oral Cavity Examination
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Prenatal presentation is done through ultrasound detection and parental counseling.
Neonatal presentation is done at birth with initial assessment including
visual and functional assessment.
Differential Diagnoses
Acute primary hepatitis stomatitis
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Aphthous ulcers
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Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
Naso-alveolar molding (NAM) is used with help of orthodontist in early infancy cases for treatment.
Orthodontic device molds protruding premaxillary segment and alveolar process for better alignment. Surgical lip adhesion is an option for wide clefts instead of presurgical orthopedics.
Safely perform surgical repair on a 10-week-old, 10-pound infant with hemoglobin at 10mg/dL.
Children with otitis media need ENT specialists for comprehensive treatment and care.
Cleft palate repair performed during 9 to 12 months, then speech evaluation and follow-up at 2- to 3-year-old to check for swallowing or speech issues.
Cleft palate leads to speech and swallowing problems due to anatomic abnormalities from the soft palate’s inability to separate air and food passages.
Cleft palate causes speech and swallowing problems due to anatomical abnormalities from the inability of the soft palate to close.
Alveolar bone grafting was performed using cancellous bone from the iliac crest to close the alveolar gap in children between 7 to 9 years old as per orthodontist’s recommendation.
Ear, nose, and throat or plastic surgery are done to correct nasal cleft deformities, scar revisions, and orthodontic procedures as needed.
by Stage
by Modality
Chemotherapy
Radiation Therapy
Surgical Interventions
Hormone Therapy
Immunotherapy
Hyperthermia
Photodynamic Therapy
Stem Cell Transplant
Targeted Therapy
Palliative Care
use-of-non-pharmacological-approach-for-cleft-lip
Use of specialized bottles and nipples for babies with cleft lip patient to ensure nutrition. Feed baby upright to prevent aspiration and ensure proper swallowing.
Instructions for caring for surgical wounds after operation, including cleaning and infection signs.
Ensure proper dental care for children with cleft palate to prevent problems. Clean air should be maintained to prevent respiratory problems in babies.
Register child in early intervention therapies for speech, occupational therapy, development services.
Regular speech and communication session can help child’s speech development to support their needs.
Proper awareness about cleft lip should be provided and its related causes with management strategies.
Appointments with an orthodontist, speech therapists and preventing recurrence of disorder is an ongoing life-long effort.
Cleft lip is a congenital deformity condition where baby’s lips are not able to develop properly during pregnancy.
It is a physical split or separation in the upper lip. Cleft lip can occur on one/both sides of lip, and it ranges from small notch to large opening extending into nose.
Cleft lip forms in early pregnancy when lip tissues do not fuse properly. Inadequate fusion of lip and palate tissues during 4 to 7 weeks of pregnancy leads to cleft formation.
Various cleft lip deformities can occur with palate. The microform or occult cleft shows incomplete lip separation with distortion but no separation of vermillion border.
Complete cleft lip has total separation of lip and nasal sill, some patient may show unilateral/bilateral cleft type.
Males have a higher incidence of left-sided cleft lips, with a 0.1% overall risk in the population.
Cleft lip is more prevalent in Asians, with a rate of 2 out of 1000 babies, compared to Caucasians and African Americans.
Cleft lip in children is linked to genetic factors and other congenital malformations up to 29%.
Malnutrition and exposure to phenytoin, steroids, tobacco, alcohol, and Accutane increase risk of cleft lip.Patient’s genetic make-up plays a major role in formation of cleft lip.
cleft lip patients have changes in anatomy. These include a short philtrum, affected philtral columns, and abnormal orbicularis oris.
Children will show consistent nasal abnormalities with a downward shifted nasal septum, detached anterior nasal spine, and rotated nasal cartilage.
Changes in facial structure affect speaking, eating, and appearance in patients.Cleft lip forms where lateral and central upper lip segments meet, that extend into maxilla and palate.
Between 3 to 6 weeks gestation, nose and lip form from first and second pharyngeal arches, known as lateral nasal processes.
Use of phenytoin in pregnancy increases the risk up to 10 times.Prenatal smoking doubles the rate of cleft lip in newborns compared to non-smoking mothers.
Van der Woude syndrome is a well-known syndrome linked to clefts of lip and palate. It is an autosomal dominant disorder with distinctive features.
Clefts in secondary palate have higher syndrome association than clefts in lip/palate.
Unilateral clefts have better prognosis than bilateral clefts, which present more complexities in treatment.
Prognosis for only cleft lip is good, but more complicated with part of syndrome or other anomalies.
Intervention within months of birth improves function and appearance results.
Skill and experience of surgical team is crucial for prognosis. Quality repair reduces complications and additional surgeries.
Clinical history includes inquiry about prenatal history, family history, and maternal health.
In developmental history include information/progress of speech and hearing ability.
Nose Examination
Ears Examination
Head and Face Examination
Oral Cavity Examination
Prenatal presentation is done through ultrasound detection and parental counseling.
Neonatal presentation is done at birth with initial assessment including
visual and functional assessment.
Acute primary hepatitis stomatitis
Pemphigus
Aphthous ulcers
Pemphigoid
Naso-alveolar molding (NAM) is used with help of orthodontist in early infancy cases for treatment.
Orthodontic device molds protruding premaxillary segment and alveolar process for better alignment. Surgical lip adhesion is an option for wide clefts instead of presurgical orthopedics.
Safely perform surgical repair on a 10-week-old, 10-pound infant with hemoglobin at 10mg/dL.
Children with otitis media need ENT specialists for comprehensive treatment and care.
Cleft palate repair performed during 9 to 12 months, then speech evaluation and follow-up at 2- to 3-year-old to check for swallowing or speech issues.
Cleft palate leads to speech and swallowing problems due to anatomic abnormalities from the soft palate’s inability to separate air and food passages.
Cleft palate causes speech and swallowing problems due to anatomical abnormalities from the inability of the soft palate to close.
Alveolar bone grafting was performed using cancellous bone from the iliac crest to close the alveolar gap in children between 7 to 9 years old as per orthodontist’s recommendation.
Ear, nose, and throat or plastic surgery are done to correct nasal cleft deformities, scar revisions, and orthodontic procedures as needed.
Otolaryngology
Use of specialized bottles and nipples for babies with cleft lip patient to ensure nutrition. Feed baby upright to prevent aspiration and ensure proper swallowing.
Instructions for caring for surgical wounds after operation, including cleaning and infection signs.
Ensure proper dental care for children with cleft palate to prevent problems. Clean air should be maintained to prevent respiratory problems in babies.
Register child in early intervention therapies for speech, occupational therapy, development services.
Regular speech and communication session can help child’s speech development to support their needs.
Proper awareness about cleft lip should be provided and its related causes with management strategies.
Appointments with an orthodontist, speech therapists and preventing recurrence of disorder is an ongoing life-long effort.
Cleft lip is a congenital deformity condition where baby’s lips are not able to develop properly during pregnancy.
It is a physical split or separation in the upper lip. Cleft lip can occur on one/both sides of lip, and it ranges from small notch to large opening extending into nose.
Cleft lip forms in early pregnancy when lip tissues do not fuse properly. Inadequate fusion of lip and palate tissues during 4 to 7 weeks of pregnancy leads to cleft formation.
Various cleft lip deformities can occur with palate. The microform or occult cleft shows incomplete lip separation with distortion but no separation of vermillion border.
Complete cleft lip has total separation of lip and nasal sill, some patient may show unilateral/bilateral cleft type.
Males have a higher incidence of left-sided cleft lips, with a 0.1% overall risk in the population.
Cleft lip is more prevalent in Asians, with a rate of 2 out of 1000 babies, compared to Caucasians and African Americans.
Cleft lip in children is linked to genetic factors and other congenital malformations up to 29%.
Malnutrition and exposure to phenytoin, steroids, tobacco, alcohol, and Accutane increase risk of cleft lip.Patient’s genetic make-up plays a major role in formation of cleft lip.
cleft lip patients have changes in anatomy. These include a short philtrum, affected philtral columns, and abnormal orbicularis oris.
Children will show consistent nasal abnormalities with a downward shifted nasal septum, detached anterior nasal spine, and rotated nasal cartilage.
Changes in facial structure affect speaking, eating, and appearance in patients.Cleft lip forms where lateral and central upper lip segments meet, that extend into maxilla and palate.
Between 3 to 6 weeks gestation, nose and lip form from first and second pharyngeal arches, known as lateral nasal processes.
Use of phenytoin in pregnancy increases the risk up to 10 times.Prenatal smoking doubles the rate of cleft lip in newborns compared to non-smoking mothers.
Van der Woude syndrome is a well-known syndrome linked to clefts of lip and palate. It is an autosomal dominant disorder with distinctive features.
Clefts in secondary palate have higher syndrome association than clefts in lip/palate.
Unilateral clefts have better prognosis than bilateral clefts, which present more complexities in treatment.
Prognosis for only cleft lip is good, but more complicated with part of syndrome or other anomalies.
Intervention within months of birth improves function and appearance results.
Skill and experience of surgical team is crucial for prognosis. Quality repair reduces complications and additional surgeries.
Clinical history includes inquiry about prenatal history, family history, and maternal health.
In developmental history include information/progress of speech and hearing ability.
Nose Examination
Ears Examination
Head and Face Examination
Oral Cavity Examination
Prenatal presentation is done through ultrasound detection and parental counseling.
Neonatal presentation is done at birth with initial assessment including
visual and functional assessment.
Acute primary hepatitis stomatitis
Pemphigus
Aphthous ulcers
Pemphigoid
Naso-alveolar molding (NAM) is used with help of orthodontist in early infancy cases for treatment.
Orthodontic device molds protruding premaxillary segment and alveolar process for better alignment. Surgical lip adhesion is an option for wide clefts instead of presurgical orthopedics.
Safely perform surgical repair on a 10-week-old, 10-pound infant with hemoglobin at 10mg/dL.
Children with otitis media need ENT specialists for comprehensive treatment and care.
Cleft palate repair performed during 9 to 12 months, then speech evaluation and follow-up at 2- to 3-year-old to check for swallowing or speech issues.
Cleft palate leads to speech and swallowing problems due to anatomic abnormalities from the soft palate’s inability to separate air and food passages.
Cleft palate causes speech and swallowing problems due to anatomical abnormalities from the inability of the soft palate to close.
Alveolar bone grafting was performed using cancellous bone from the iliac crest to close the alveolar gap in children between 7 to 9 years old as per orthodontist’s recommendation.
Ear, nose, and throat or plastic surgery are done to correct nasal cleft deformities, scar revisions, and orthodontic procedures as needed.
Otolaryngology
Use of specialized bottles and nipples for babies with cleft lip patient to ensure nutrition. Feed baby upright to prevent aspiration and ensure proper swallowing.
Instructions for caring for surgical wounds after operation, including cleaning and infection signs.
Ensure proper dental care for children with cleft palate to prevent problems. Clean air should be maintained to prevent respiratory problems in babies.
Register child in early intervention therapies for speech, occupational therapy, development services.
Regular speech and communication session can help child’s speech development to support their needs.
Proper awareness about cleft lip should be provided and its related causes with management strategies.
Appointments with an orthodontist, speech therapists and preventing recurrence of disorder is an ongoing life-long effort.
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