Cleft Lip and Cleft Palate: Causes, Diagnosis, and Management

Introduction of CLCP:

Cleft lip is a congenital condition easily identifiable at birth; however, detecting cleft palate requires a thorough examination of the oral cavity1. A cleft in the soft palate can often be overlooked unless the newborn undergoes a meticulous evaluation. One of the most frequently associated congenital anomalies with cleft palate is a ventricular septal defect (VSD) 2.

Pathophysiology: 

Cleft lip and cleft palate occur due to the failure of fusion during the organogenic period of fetal development. Cleft lips typically develop between 6 to 8 weeks of gestation and may present unilaterally or bilaterally, ranging from a slight notch in the lip to a deep extension into the nasal cavity. Similarly, cleft palates form between 7 to 12 weeks of gestation, resulting from incomplete fusion of the palatal structures.

Pierre-Robin Syndrome and Feeding Challenges:

In Pierre-Robin syndrome, cleft palate is accompanied by a retracted lower jaw (micrognathia) and an enlarged tongue (macroglossia), leading to glossoptosis. In this condition, the tongue tends to fall backward, causing airway obstruction3. Feeding difficulties are common in infants with cleft palate. Initially, gavage feeding or spoon-feeding is recommended during the first few days4. Special bottle-feeding techniques using a soft nipple with a rubber flange can aid in closing the cleft and facilitating sucking. If conventional feeding methods prove ineffective, a palatal prosthesis can assist in feeding5.

Multidisciplinary Management Approach:

The management of cleft palate necessitates a coordinated effort by a team of healthcare specialists, including a pediatrician, plastic surgeon, orthodontist, ENT specialist, and speech therapist6. The surgical repair of cleft lip is typically performed by three months, whereas cleft palate repair is generally deferred until the child reaches two years of age7.

References:

1. Ghai OP. Essential Pediatrics. 9th ed. New Delhi: CBS Publishers; 2019. p. 345-347.
2. Wong DL, Hockenberry MJ, Wilson D. Wong's Essentials of Pediatric Nursing. 11th ed. St. Louis: Mosby; 2023. p. 512-514.
3. Nelson WE, Behrman RE, Kliegman RM, Arvin AM. Nelson Textbook of Pediatrics. 21st ed. Philadelphia: Elsevier; 2022. p. 1421-1423.
4. Ghai OP. Essential Pediatrics. 9th ed. New Delhi: CBS Publishers; 2019. p. 348.
5. Wong DL, Hockenberry MJ, Wilson D. Wong's Essentials of Pediatric Nursing. 11th ed. St. Louis: Mosby; 2023. p. 516-518.
6. Nelson WE, Behrman RE, Kliegman RM, Arvin AM. Nelson Textbook of Pediatrics. 21st ed. Philadelphia: Elsevier; 2022. p. 1425-1426.
7. Ghai OP. Essential Pediatrics. 9th ed. New Delhi: CBS Publishers; 2019. p. 349