Snapshot A 35-year-old mother brings her 1-week-old female infant to your clinic for difficulty with breastfeeding. The mother reveals that she had no prenatal care during her pregnancy and gave birth at home. She notes that her infant has difficulty latching onto her nipple and she occasionally sees breast milk coming out of the infant’s nose. On examination, you note that there are no obvious facial deformities, however, inspection of the oral cavity reveals a defect in the hard palate and visualization into the nasal cavity. You then decide to refer the patient to a craniofacial clinic. Introduction Etiology causes are multifactorial Genetics concordance rate for monozygotic twins is approximately 40-60% suggests that genetics does not act alone Epidemiology incidence predominant congenital anomaly of the head and neck login to view 4 more bullets of the known 200 syndromes associated with cleft lip and palate, van der Woude syndrome is the most common login to view 2 more bullets risk factors alcohol tobacco phenytoin retinoic acid Studies Prenatal ultrasound can diagnose facial deformities as early as 18 weeks accuracy improves with gestational age upon diagnosis infant and family are immediately referred to a craniofacial center for management Following diagnosis, infant is screened for any other congenital abnormalities Treatment Primary treatment is surgical correction Children with cleft palate often have difficulty sucking due to air leakage between the nose and mouth breast-feeding is often ineffective and specialized bottles with positional techniques are available to ensure adequate intake surgery for cleft lip is usually performed around 3 months of age surgery for cleft palate is usually performed around 1 year of age, when speech is beginning to develop orthodontic devices may be used to decrease size of cleft lip prior to definitive repair Referral to a craniofacial clinic is necessary and comprises multiple specialists that include otolaryngology plastic surgery oral maxillofacial surgery dentistry genetic counseling speech-language pathology and audiology Cleft Lip Cleft lip Pathophysiology maxillary and medial nasal prominences (intermaxillary segment) fail to fuse together resulting in the characteristic persistent labial groove (cleft lip) complete vs. incomplete cleft lip bilateral vs. unilateral Cleft Palate Pathophysiology can be divided into anterior and posterior cleft palate demarcating line is incisive foramen anterior cleft palate login to view 1 more bullet posterior cleft palate login to view 1 more bullet anteroposterior cleft palate login to view 1 more bullet Note cleft lip and cleft palate have separate embryological causes but many times occur together