True about cleft palate are all except
Cleft lip and palate Clefts of the lip, alveolus & hard and soft palate are the most common congenital abnormalities of the orofacial structures Frequently occur as isolated deformities but can be associated with other medical condition, paicularly congenital hea disease Incomplete clefts affect only a poion of the lip and contain a bridge of tissue connecting the central & lateral lip elements, referred to as Simon a's band Cleft lip is due to Non-fusion of maxillary process with medial nasal process Unilateral cleft lip is associated with posterior displacement of alar cailage Distribution In unilateral cleft lip the deformity affects the left side in 60% of cases Typical distribution of cleft types Cleft lip alone :15% CCleft lip & palate :45% (MC) Isolated cleft palate : 40% Etiology of cleft lip and palate Etiology of cleft lip & palate : Genetic Predisposition & a contributory environmental component Environmental factors : Maternal epilepsy & drugs (steroids, diazepam & phenytoin) Associated syndromes Although most cleft lip & palate occur as an isolated deformity, pierre Robin sequence remains the most common syndrome. Other associated syndromes : Stickler's (ophthalmic and musculoskeletal abnormalities), Shprintzen's (Cardiac anomalies), Down's, Ape's and Trecher-Collins' syndromes Types of cleft lip Types of cleft palate Unilateral cleft lip Bilateral cleft lip Incomplete : Cleft of the hard palate remains attached to the nasal septum and vomer Complete : Nadal septum and vomer are completely seperated from the palatine process Antenatal diagnosis All but isolated cleft palate can be diagnosed by ultrasound after 18 weeks gestation Problems immediately after bih All but isolated cleft palate can be diagnosed by ultrasound after 18 weeks gestation Problems immediately after bih Some babies are able to feed normally but some will need assistance Breathing problems in Pierre Robin sequence may be life threatening Management Surgical techniques are aimed at restoring normal anatomy Cleft lip: Repaired between 3 and 6 months of age Cleft palate : Repaired between 6 and 18 months of age Principles of surgery Cleft lip surgery attaches and reconnects the muscles around the oral sphincters Cleft palate surgery aims to bring together mucosa and muscles with minimal scaring Two-stage procedures attempt to minimize dissection Secondary management Following primary surgery, regular review by a multidisciplinary team is essential Many aspects of cleft care require long-term review : Hearing, speech, dental development, facial growth Ref: Sabiston 20th edition Pgno :1946-1947
Surgery should be done at 1 year
50% recover speech after operation
A/w hearing loss
A/w cleft lip in 45%
Head and neck