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Cleft lip The abnormalities in cleft lip are the direct consequence of disruption of the muscles of the upper lip and nasolabial region. The muscle continuity is disrupted, leading to the cleft lip and also abnormal insertions of the muscle at the cleft edg...

Cleft palate Embryologically , the primary palate consists of all anatomical structures anterior to the incisive foramen, namely the alveolus and upper lip. The secondary palate is defined as the remainder of the palate behind the incisive foramen, divided in...

DIAGNOSIS The diagnosis of the craniofacial anomalies has, in recent years, undergone a massive change on two fronts: first, advances in ultrasonography have increased the rate of prenatal diagnosis and impacted management significantly; second, the rapid expa...

EPIDEMIOLOGY The incidence of congenital craniofacial anomalies varies in di ff erent parts of the world and is often not easy to quantify . Table 50.2 outlines the various incidences of the more common craniofacial abnormalities. TABLE 50.2 Approximate inci...

Immediate/neonatal care Feeding Babies born with a cleft involving the palate will feed well and thrive, provided that they receive the appropriate CNS input. The feeding aids for a child with a cleft palate aim to improve the e ffi ciency of delivery of milk...

Incidence The incidence of cleft lip and/or palate is around 1:600 live births. There are geographical and ethnic variations, with a higher incidence among the South East Asian and Native American populations than elsewhere in the world. The accu - racy of th...

INTRODUCTION Congenital abnormalities of the head and neck are complex and often confusing. For these reasons it is helpful to have a classification system that helps to understand the variety of conditions. For any classification system to be useful it should ...

Learning objectives To understand: The range and complexity of craniofacial anomalies • The principles driving interventions for the developing • child with a craniofacial anomaly

MANAGEMENT In considering the management of this vast range of heteroge neous congenital abnormalities it is very di ffi cult to generalise about management protocols. The vast majority of manage ment is delivered by multidisciplinary teams (MDTs) within spec...

Management in early childhood (1–12 years) In early childhood management should be aimed at dealing with functional problems – airway obstruction, speech and feeding issues – but there is an increasing imperative for surgery to address the appearance of the c...

Management in infancy (0–12 months) At this age treatment falls into two categories: that directed at - major functional issues as for neonatal care and that directed at skull surgery in cases of craniosynostosis. same; however, there is the possibility of s...

Neonatal management In the neonatal period management is aimed at addressing the urgent issues relating to the airway , breathing, eye protection and establishing feeding. In many of the craniofacial conditions the airway can be a ff ected and may be fully or ...

Orthodontic treatment Children with cleft lip and alveolar involvement will often benefit from orthodontic treatment. Orthodontic treatment is commonly carried out in two phases: 1 Mixed dentition (8–10 years): to prepare the alveolar cleft for ABG (see Alveola...

Orthognathic surgery Impaired growth of the midface (maxilla) is a consequence of a number of factors, which are poorly understood. Genetic factors as well as local factors following primary surgery may be involved. Elective maxillary advancement or bimaxill...

PRINCIPLES OF CLEFT SURGERY The ultimate aim in cleft lip and palate management is to facilitate normal development and well-being. In seeking this, surgical repair is aimed at producing normal anatomy in the lip, nose and palate. Essentially , oral and dental...

SECONDARY/REVISION SURGERY These procedures are undertaken to improve aesthetics and/ or function. They may be considered as procedures that were unplanned at the time of primary surgery . Specific examples are as follows.

SUMMARY Cleft care has been the subject of significant reorganisation in recent years. Coordinated care is provided in most countries by MDTs. Specific training pathways exist in many countries for cleft surgery . Better collection and collation of outcome dat...

Surgical techniques Much debate and variation exist across the world in the timing and techniques employed in cleft repair. All have the common aims stated above. Restoration of form and function can be achieved using many of these protocols, but the followi...