Cleft Lip and Palate and Craniofacial Syndromes
Core concepts
Understand the embryology of lip and palate fusion, the rule of tens for cleft lip timing, and the sequencing of cleft care (lip repair, palate repair, alveolar bone graft, orthodontics, speech surgery). Know Pierre Robin sequence and 22q11.2 deletion.
Traps in questions
- Confusing cleft lip timing (rule of tens: weight, hemoglobin, age) with palate repair timing.
- Missing airway management in Pierre Robin sequence (micrognathia, glossoptosis).
- Forgetting that alveolar bone grafting is timed with mixed dentition.
- Overlooking velopharyngeal insufficiency after palate repair.
Rule of thumb
The rule of tens for cleft lip repair: about 10 weeks of age, 10 pounds, and 10 g/dL hemoglobin.
Worked example
A neonate with micrognathia and glossoptosis has respiratory distress. The question asks the diagnosis. The rule: this is Pierre Robin sequence; positioning and airway support come first, with mandibular distraction reserved for refractory cases. Missing the airway priority is the classic error.