Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- bilateral cleft lip ± palate
- unilateral cleft lip ± palate
- isolated cleft palate
- microform cleft lip
- isolated sub-mucous cleft palate
- positive antenatal ultrasound
Other diagnostic factors
- difficulty feeding
- poor weight gain
- airway obstruction
Risk factors
- genetic predisposition
- dysmorphic syndrome
- anticonvulsant drugs
- maternal tobacco use
- maternal alcohol consumption
- folic acid deficiency
Diagnostic investigations
1st investigations to order
- audiogram
Investigations to consider
- auditory brain stem response (ABR) test
- vertebral spine x-rays
- renal ultrasound
- fluorescence in situ hybridisation (FISH)
Treatment algorithm
complete cleft lip and palate
isolated cleft palate
isolated cleft lip
Contributors
Authors
Travis T. Tollefson, MD, MPH, FACS

Professor and Director
Facial Plastic and Reconstructive Surgery
Otolaryngology - Head and Neck Surgery
Cleft and Craniofacial Team
University of California Davis
Sacramento
CA
Disclosures
TTT has received an honorarium and reimbursement for travel by the AO Foundation for teaching on a facial trauma course. TTT serves on the American Board of Otolaryngology and the American Board of Facial Plastic and Reconstructive Surgery, and receives a royalty from Thieme publishing for the textbook Complete Cleft Care. TTT is an author of studies referenced in this topic.
David A. Shaye, MD

Instructor
Facial Plastic and Reconstructive Surgery
Massachusetts Eye and Ear
Harvard University
Boston
MA
Disclosures
DAS has received an honorarium and reimbursement for travel by the AO Foundation for teaching on a facial trauma course.
Peer reviewers
Oren Friedman, MD
Assistant Professor to Director
Division of Facial Plastic and Reconstructive Surgery
Mayo Clinic
Rochester
MN
Disclosures
OF declares that he has no competing interests.
Philip Fischer, MD
Professor of Pediatrics
Mayo Clinic
Rochester
MN
Disclosures
PF declares that he has no competing interests.
Guidelines
- Parameters for evaluation and treatment of patients with cleft lip/palate or other craniofacial differences
- Palate examination: identification of cleft palate in the newborn
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