Cleft Lip and Palate and Craniofacial Anomalies
Classification and embryology
Understand the embryology of the face and the timing of palatal fusion, and know the difference between cleft lip with or without cleft palate and isolated cleft palate. Know the classification systems and the associated syndromes - Van der Woude, Stickler, Treacher Collins, and Pierre Robin sequence - and the importance of a multidisciplinary team.
Management
Know the sequencing of care: presurgical molding, lip repair, palatal repair, alveolar bone grafting, orthodontics, and speech therapy. Understand the timing of alveolar bone grafting, usually in the mixed dentition before canine eruption, and the role of orthodontics in preparing the arch. Know the common dental anomalies - hypodontia, supernumerary teeth, and enamel defects.
Traps
Questions often test the timing of procedures and the reasons behind them, such as why palatal repair occurs before speech develops. Another trap is confusing the management of cleft lip with that of cleft palate, or ignoring the role of the team. Watch for questions that assume all clefts are syndromic.
Worked example
A child with a unilateral cleft lip and palate and a missing lateral incisor in the cleft region. Rule of thumb: alveolar bone grafting is typically performed in the mixed dentition, before the canine erupts, to provide bone support for the tooth and stabilize the arch.