Cleft Lip and Palate Overview

A split in the upper lip, sometimes extending to the nostril.

A split in the upper lip that goes all the way through, reaching the nostril.

A split in the upper lip that is not complete, meaning there is some tissue connecting the two sides.

A split in the roof of the mouth (palate), sometimes extending to the hard palate.

A birth defect where the lip is split, can be either complete or incomplete.

The process of a cleft palate forming during the first trimester of pregnancy.

The process of a cleft lip forming during the first trimester of pregnancy.

A birth defect where the palate is split, can be either complete or incomplete.

The most frequent complications associated with cleft palate surgeries involve the airway, such as difficulty intubating, accidental extubation during the procedure, and airway obstruction after surgery.

Before a cleft palate surgery, it's crucial to check for any additional birth defects. These could include syndromes like Pierre-Robin Syndrome, Goldenhar Syndrome, and Treacher Collins Syndrome, or congenital heart disease.

A common concern in children with cleft palate is chronic rhinorrhea. This means they often experience runny noses due to food refluxing up into their nasal passages.

Obstructive sleep apnea syndrome is a condition related to blocked breathing during sleep. It's important to be aware of it in cleft palate patients as they are more sensitive to the effects of anesthesia, sedatives, and painkillers.

Due to recurring oxygen deficiency caused by airway obstruction, some cleft palate patients may develop right ventricular hypertrophy (enlarged right ventricle) and cor pulmonale (heart problems).

Intubation, the placement of a breathing tube, is more challenging in children younger than 6 months with cleft palate, especially if they have retrognathia (receding lower jaw) or bilateral clefts.

Children with cleft palate may experience feeding difficulties, leading to nutritional deficiencies and anemia.

The successful anesthetic management for cleft palate surgery depends on the patient's age, available monitoring equipment, anesthetic drugs, and the expertise of the medical team.

Premedication with sedatives is not recommended for infants with cleft palates due to the increased risk of airway obstruction.

Atropine is used to reduce saliva production during surgery, helping to improve visibility and airway management.

Inhalational anesthesia with halothane or sevoflurane is the preferred method for inducing anesthesia in children undergoing cleft palate surgery.

Neuromuscular blocking agents are not administered until the airway can be easily managed by a mask, ensuring adequate ventilation.

Endotracheal intubation can be challenging due to the anatomical alterations in cleft palate patients. Different techniques like blind nasal intubation, fiberoptic intubation, or bougies may be necessary.

The oral RAE tube is commonly used for cleft palate surgery and is positioned in the midline. A mouth gag helps maintain airway patency by keeping the mouth open and the tongue out of the way.

Maintaining a secure airway with a well-positioned endotracheal tube is crucial to avoid kinking and ensure ventilation.

Homeostasis maintenance during surgery is important. Monitoring hypercapnia and preventing adrenaline-induced arrhythmias are key considerations.

A breathing technique using halothane where the patient breathes spontaneously, providing safety in case of accidental disconnection or extubation, but not suitable for very young infants.

A breathing technique where the patient's muscles are paralyzed, allowing for a lighter level of anesthesia and quicker recovery with less bleeding.

Local injections used to reduce bleeding, improve surgical view, and provide some pain relief during surgery.

A drug used in local infiltrations to reduce bleeding, only used in the presence of normal carbon dioxide levels and halothane anesthesia.

Short-acting painkillers used to ensure a smoother recovery after surgery with less crying after the breathing tube is removed.

Nerve blocks that provide excellent pain relief before and after surgery, without causing breathing difficulties.

A nerve that branches from the trigeminal nerve and controls sensation in the upper lip, lower eyelid, and side of the nose.

Blocking the infraorbital nerve by injecting anesthetic medication near its exit point, providing effective pain relief.