Anaesthesia for cleft lip and palate surgery

The presence of a cleft lip, cleft palate or both, has a huge impact on the life of an individual and their family. Modern management has much to offer these people, revolutionizing appearance and functional defects to a point where they may be difficult to detect. Surgery aims to correct the anatomically obvious cleft lip, augment normal dento-alveolar development and lead to effective palatal function. Worldwide, cleft lip and palate (CLP) is one of themore common congenitalmalformations. In the UK, the incidence is around 1:700, amounting to 1000 babies every year presentingwith cleft lip and/or palate (Table 1). CLP is more common in males; strangely, cleft lips are usually left-sided. The aetiology is often unknown, though likely to result from both environmental and genetic causes. The incidence is greater than expected amongst first-degree relatives of those with CLP. Both cleft lip and palate occur as a result of defects in palatal growth during the first trimester. The palate grows inwards to fuse in the midline in two stages. By 6weeks the primary palate forming the alveolus and lip fuses, followed 8 weeks later by the secondary palate, which is posterior to the incisive foramen. The window of opportunity for fusion to occur is relatively short, and suggested theories for failure of fusion include mechanical obstruction by tongue position, structural hypoplasia or primary breakdown. Clefts of the lip and alveolus can be diagnosed reliably at the routine 18–20 week antenatal ultrasound scan, allowing for earlier preparation of support services and counselling of parents. Clefts of the palate are not easily seen by ultrasound and can only be excluded by examination of the palate after delivery.