Figure 116.1 Cleft lip and palate
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Cleft lip and palate
Cleft lip and palate is a relatively common facial anomaly in babies, which varies in frequency according to racial or ethnic group. The prevalence of cleft lip and palate is highest in native Indians, followed by Chinese and Japanese communities. It is lowest in Afro-Caribbean and Maoris.
Cleft services
Cleft lip and palate is managed by a multidisciplinary team including clinical nurse specialists, paediatricians, surgeons, speech and language therapists, physiologists and orthodontists. Nine regional networks exist in the United Kingdom to facilitate high standards of care based on a hub and spoke principle.
Support and management
Patients with cleft and their families are seen according to nationally agreed standards and care pathways from birth until adulthood. Treatment includes surgical repair of the lip and/or palate, usually in the first year of life. Further treatment includes speech and language therapy, hearing and dental interventions.
Common problems and their management
Feeding management
In an infant without cleft, the uvula and epiglottis lie adjacent to each other which allows fluid to pool safely in the hyperpharynx or oropharynx until the swallowing reflex is triggered. In infants with cleft, the anatomical differences prevent this safety mechanism, resulting in the risk of aspiration if inappropriately fed.
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