Week 18 Q&A

You attend the delivery of an infant girl who was noted to have a cleft lip on prenatal ultrasound.

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On your initial exam, she is found to have a complete unilateral cleft lip and palate. (See Figure 9–4.) The family has lots of questions regarding this diagnosis.

Figure 9-4. 

This infant has a complete unilateral cleft lip that extends into the nasal sill. (Reproduced with permission from Lalwani AK, ed. Current Diagnosis & Treatment in Otolaryngology: Head and Neck Surgery. 3rd ed. McGraw-Hill Education; 2011, Fig 20-4.)

All of the following are true regarding cleft lip and palates EXCEPT:

A. Cleft lip occurs most often on the left side. 

B. Right-sided clefts are more commonly associated with syndromes. 

C. There is no association between a bifid uvula and a cleft palate. 

D. Cleft lip is more common in males and cleft palate in females. 

E. Almost all children with cleft lip and palate require myringotomy and tympanostomy tube placement due to eustachian tube dysfunction. 

The correct answer is “C.” A bifid uvula is present in approximately 3% of children but there is an association with submucous cleft palate. A submucous cleft palate is diagnosed by the classic triad of a bifid uvula, central thinning of the soft palate, and a palpable notch in the posterior border of the hard palate. It is important to identify this abnormality because affected children have a 40% risk of developing persistent middle ear effusions and are at risk for velopharyngeal incompetence resulting in hypernasal speech.

Source: Peterson AR, Wood KE. Pediatrics Examination and Board Review; 2017.

Leah Carton

Associate Editor - Pediatrics, Dermatology, Geriatrics , McGraw Hill