Most common congenital anomaly of the face is:March 2009

Ans. C: Cleft lip and cleft palateThe 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 monthsBilateral-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 processCleft 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 indicatedSoft palate only-One operation at 6 monthsSoft 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.