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Treatment and Management

Neonatal Care

When a neonate with a cleft is born, a pediatrician has 3 major concerns:

  • Risk of aspiration because of communication between oral and nasal cavities
  • Airway obstruction (in addition to sequelae of aspiration, especially in Robin sequence in which the cleft palate [CP] is combined with micrognathia and the tongue has a normal size)
  • Difficulties with feeding of a child with a cleft and nasal regurgitation

These 3 factors are influenced by the presence of other major or minor anomalies that may, in association with a cleft, represent 1 of 300 known cleft syndromes. Therefore, a neonate with an orofacial cleft should be seen by a medical geneticist as soon as possible.

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Multidisciplinary Team

Most individuals with cleft lip, cleft palate, or both (and many individuals with other craniofacial anomalies) require the coordinated care of providers in many fields of medicine and dentistry, as well as those in speech pathology, otolaryngology, audiology, genetics, nursing, mental health, and social medicine.

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Surgical Therapy

Undoubtedly, closure of the cleft lip is the first major procedure that tremendously changes children's future development and ability to thrive. Variations occur in timing of the first lip surgery; however, the most usual time occurs at approximately age 3 months. Pediatricians used to strictly follow a rule of "three 10s" as a necessary requirement for identifying the child's status as suitable for surgery (ie, 10 lb, 10 mg/L of hemoglobin, and age 10 wk). Although pediatricians are presently much more flexible, and some surgeons may well justify a neonatal lip closure, considering the rule of three 10s is still very useful.

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