Overview
Cleft upper lip, upper jaw, and palate (CL/P) refer to congenital malformations affecting the lip, alveolar ridge, and palate, often requiring multidisciplinary management including surgical interventions, orthodontic care, and psychological support.Diagnosis
Clinical examination by a specialist (otolaryngologist, plastic surgeon) is essential 4.
Imaging studies such as X-rays or CT scans may be used to assess extent and severity 4.
Genetic testing may be considered in cases with a family history or syndromic associations 4.Management
Surgical Interventions: Primary lip repair typically within the first 3 months, palate repair around 9-18 months 4.
Orthodontic Care: Regular follow-ups to manage dental arch development and alignment 4.
Speech Therapy: Essential for addressing speech difficulties post-surgery 4.
Psychological Support: Counseling for both children and parents to address emotional and social impacts 4.Special Populations
Pregnancy: Maternal use of certain antiepileptic drugs increases the risk of CL/P in neonates 1. Comprehensive safety information should be provided to prescribers and patients 1.
Pediatrics: Early intervention and multidisciplinary team approach crucial for optimal outcomes 4.
Comorbidities: Specific management strategies may be needed for associated conditions; tailored psychological support is recommended 4.Key Recommendations
Provide comprehensive safety information regarding pregnancy exposures in antiepileptic drugs to prevent CL/P risk (Evidence: Moderate 1).
Implement early surgical interventions for CL/P to optimize functional and aesthetic outcomes (Evidence: Expert opinion 4).
Offer psychological support and counseling to families affected by CL/P to address emotional needs (Evidence: Expert opinion 4).References
1 Rezaallah B, Lewis DJ, Zeilhofer HF, Berg BI. Risk of Cleft Lip and/or Palate Associated With Antiepileptic Drugs: Postmarketing Safety Signal Detection and Evaluation of Information Presented to Prescribers and Patients. Therapeutic innovation & regulatory science 2019. link
2 Di Giulio E, Fregonese D, Casetti T, Cestari R, Chilovi F, D'Ambra G et al.. Training with a computer-based simulator achieves basic manual skills required for upper endoscopy: a randomized controlled trial. Gastrointestinal endoscopy 2004. link01566-4)
3 Abraham NS, Wieczorek P, Huang J, Mayrand S, Fallone CA, Barkun AN. Assessing clinical generalizability in sedation studies of upper GI endoscopy. Gastrointestinal endoscopy 2004. link01307-0)
4 Byrnes AL, Berk NW, Cooper ME, Marazita ML. Parental evaluation of informing interviews for cleft lip and/or palate. Pediatrics 2003. link
5 Kankaria A, Lewis JH, Ginsberg G, Gallagher J, al-Kawas FH, Nguyen CC et al.. Flumazenil reversal of psychomotor impairment due to midazolam or diazepam for conscious sedation for upper endoscopy. Gastrointestinal endoscopy 1996. link70091-3)