Cleft lip and palate — formative SAQs

SAQ 1 (10)

A newborn is diagnosed at the postnatal check with a complete unilateral cleft of the lip and palate on the left side. The baby weighs 3.2 kg, is otherwise well, and the mother is anxious about feeding. The newborn hearing screen refers on both sides. [2]

a) State the Veau grade of this cleft, and explain the embryology that produced it. (3 marks) [1]

b) Describe the feeding technique you would teach the mother on day one, naming the type of bottle or teat and the feeding position, and explain why a standard nipple or the breast is unlikely to succeed. (3 marks) [7]

c) Outline the staged surgical timeline from now through to adolescence, naming the age of the lip repair, the palatoplasty and the alveolar bone graft. (2 marks) [2]

d) Explain the cause of the near-universal otitis media with effusion in cleft palate, and state the timing and the purpose of the first ventilation tubes (grommets). (2 marks) [10] [11]

SAQ 2 (10)

A three-day-old baby is transferred to the neonatal unit because of noisy breathing and desaturation when supine. Examination reveals a small recessed chin, a wide U-shaped cleft of the palate, and a tongue that falls back into the pharynx. The baby feeds poorly and chokes. [8]

a) Name the clinical sequence, describe the triad, and explain why it is called a sequence rather than a syndrome. (3 marks) [8]

b) Outline the immediate airway management, naming two non-operative interventions and one surgical option for refractory cases, and explain why the airway takes priority over the palate and feeding. (3 marks) [9]

c) Name two syndromes associated with this sequence and the specific additional evaluation each requires. (2 marks) [8]

d) Contrast the shape of the palatal cleft in this baby (U-shaped) with the typical shape in an isolated non-syndromic cleft palate (V-shaped), and explain the mechanical reason for the difference. (2 marks) [8]