Most common congenital anomaly of the face is: March 2009

Ans. C: Cleft lip and cleft palate The typical distribution of cleft types is: Cleft lip alone-15% Isolated cleft palate-40% Cleft lip and cleft palate-45% Cleft lip alone (hare lip): It is due failure of fusion between the frontonasal (philtrum) and the maxillary processes. Types : - Unilateral 85% usually on the left side 75%, bilateral 15%. - Upper or lower: lower cleft lip is very rare and is due to failure of fusion between the mandibular processes. Complete or incomplete: according to whether it extends to the nostrils or not. - Simple or alveolar: if it involves the bony alveolus. - Complicated or not: If it is associated with cleft palate. Complications: - Disfigurement. - Difficult suckling if it is complicated. Treatment: - Timing of surgery for cleft lip alone: Unilateral-one operation at 5-6 months Bilateral-One operation at 4-5 months. - (Millard's operation- When the patient is 10 weeks old, Hb = 10 gm% and the weight is 10 pounds (rule of ten)). II. Isolated cleft palate: The palate is developed from - Premaxilla from the frontonasal process. - Two maxillary shelves: from the maxillary process Cleft palate occurs due to failure (total or paial) of fusion between the maxillary and frontonasal process or the 2 maxillary processes. Types : - Soft palate only, usually asymptomatic. - Intermaxillary : the cleft is only between the 2 maxillary shelves. - Bipaate : as intermaxillary but extends to one side of the premaxilla. Tripaate : as intermaxillary but extends to both sides of the premaxilla. Complications: - Impaired feeding due to: Difficult suckling. Wide pharynx : so the soft palate can't close the nasopharynx during swallowing leading to nasal regurgitation of food, leading to pharyngitis, rhinitis, otitis media and deafness. Difficult speech : specially consonant e.g. D, P, T, B, K, J. - Teeth malformation. Pierre Ribon syndrom : Cleft palate with receding lower jaw (micrognathia) and posterior displacement of the tongue which obstruct air way. - Malformed nose. Treatment : In cases of cleft palate alone, surgical correction is indicated Soft palate only-One operation at 6 months Soft and hard palate-Two operations. One for soft palate at 6 months and another for hard palate at 15-18 months. - In case of cleft lip and palate, surgical correction is done at; Unilateral- two operations-Cleft lip and soft palate at 5-6 months and hard palate and gum pad with or without lip revision at 15-18 months. Bilateral- two operations-Cleft lip and soft palate at 4-5 months and hard palate and gum pad with or without lip revision at 15-18 months.