xRead - Treatment of Cleft Lip and Cleft Palate (May 2025)
CME
Evidence-Based Practices in Cleft Palate Surgery
Sarah A. Applebaum, MD Sofia Aronson, MD Kareem M. Termanini, MD Arun K. Gosain, MD Chicago, IL
Learning Objectives: After studying this article, the participant should be able to: (1) Understand the embryologic origins, cause, and incidence of cleft pal ate. (2) Review the anatomy and common classifications of cleft palate and associated defects. (3) Describe surgical techniques for palatoplasty and under stand their respective indications. (4) Gain an awareness of general periop erative care considerations, timing of repair, and risk factors for and operative mitigation of complications. Summary: Cleft palate affects 0.1 to 1.1 per 1000 births, with a higher incidence in certain ethnic groups but affecting both sexes equally. Cleft palate may occur in isolation or in combination with cleft lip or in association with other con genital anomalies including various syndromes. The goals of cleft palate repair are to anatomically separate the oral and nasal cavities for normal feeding and improved speech and minimize the risk of oronasal fistulas, velopharyngeal dys function, and disruption of facial growth. This review discusses the incidence, causes, and classification of cleft palate; surgical techniques for palatoplasty and perioperative patient management; and complications of palatoplasty. (Plast. Reconstr. Surg. 153: 448e, 2024.)
CLEFT PALATE ANATOMY, EMBRYOLOGY/CAUSE, EPIDEMIOLOGY Epidemiology of Cleft Palate Cleft palate affects 0.1 to 1.1 per 1000 births 1 ; cleft palate alone has a slight female predomi nance but overall affects both sexes equally, and is more common in Asian, Latin, and Native American children and least common in people of African descent. 2–5 Cleft palate may occur in isolation or in combination with cleft lip and other orofacial clefts or in association with over 150 syndromes, including Stickler syndrome, Down syndrome, Treacher Collins syndrome, Beckwith-Wiedemann syndrome, syndromic craniosynostosis, and Pierre Robin sequence. 6,7 Children with cleft palate, especially those with syndromic associations, may have additional air way abnormalities that must be evaluated and considered during perioperative cleft manage ment. 8 Clefting may also occur as a result of exposure to teratogens such as alcohol, tobacco smoke, anticonvulsant drugs, and organic From the Division of Plastic Surgery, Ann & Robert H. Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine. Received for publication October 15, 2022; accepted August 18, 2023. Copyright © 2024 by the American Society of Plastic Surgeons DOI: 10.1097/PRS.0000000000011035
solvents. 7 In addition, in a study of over 6 mil lion live births, cleft palate was found to be asso ciated with low maternal socioeconomic status, prepregnancy tobacco smoking, and maternal infections. 5 Relevant Anatomy Cleft palate refers to clefting specifically of the secondary palate, which includes the hard palate posterior to the incisive foramen and the soft palate or velum including the uvula. The primary palate is the triangular region anterior to the incisive foramen including the alveolus, and clefting here is semantically housed under the terms “cleft lip” or “cleft alveolus,” which are distinct from “cleft palate,” although they often occur concurrently. The soft palate con tains the palatal muscles responsible for eleva tion and used in phonation, including the paired tensor veli palatini and paired levator pala tini muscles. The levator muscles are normally
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448e
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Copyright © 2024 American Society of Plastic Surgeons. Unauthorized reproduction of this article is prohibited.
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