Cleft and Craniofacial Anomalies
Cleft and Craniofacial Anomalies
This domain tests embryology, team-based timing, airway management, and speech outcomes in cleft and craniofacial care. The exam expects a longitudinal plan rather than a single operation.
Core rules
- Cleft lip forms from failed fusion of facial processes around 4–7 weeks; cleft palate around 6–12 weeks.
- A cleft team includes surgery, orthodontics, speech therapy, audiology, genetics, and psychology.
- Cleft lip repair often follows the rule of 10s: about 10 weeks, 10 lb, and 10 g/dL hemoglobin; palate repair is usually 9–12 months.
- Alveolar bone grafting is typically performed at 6–9 years, before canine eruption.
- Pierre Robin sequence includes micrognathia, glossoptosis, and airway obstruction; positioning or mandibular distraction may be needed.
Worked example
A newborn has a unilateral cleft lip and palate. Reasoning: feeding support and hearing assessment begin early; lip repair is planned around 3–6 months; palate repair around 9–12 months; alveolar grafting later. Speech and velopharyngeal function are monitored throughout.
Traps
Delaying palate repair without reason; ignoring hearing loss; missing airway obstruction in Pierre Robin sequence; confusing cleft lip and palate timing; failing to plan speech assessment.