Learning Objectives: After reading this article, the participant should be able to: 1. Understand the embryology of normal palate development, and the genetic and environmental causes of clefting. 2. Delineate the anatomy of the normal palate and the cleft palate. 3. Understand the Veau classification for clefts of the palate and techniques used to repair various clefts of the palate. 4. Understand the factors that contribute to complications following palate repair, including fistula formation, velopharyngeal insufficiency, maxillary growth inhibition, and sleep apnea.
Summary: Cleft palate is generally an isolated congenital abnormality but can be associated with multiple syndromes. Careful evaluation of an infant with cleft palate by a multidisciplinary team is required to rule out other potential abnormalities. In children with isolated nonsyndromic cleft palate, palate repair is generally performed before 1 year of age. The goals for cleft palate repair include separating the nasal and oral cavities (avoidance of fistulas), establishing normal velopharyngeal function, and preserving maxillofacial growth. This module reviews the incidence, epidemiology, and anatomical classification of cleft palates; and repair techniques, timing, and potential complications associated with palate repair.
The Maintenance of Certification module series is designed to help the clinician structure his or her study in specific areas appropriate to his or her clinical practice. This article is prepared to accompany practice-based assessment of preoperative assessment, anesthesia, surgical treatment plan, perioperative management, and outcomes. In this format, the clinician is invited to compare his or her methods of patient assessment and treatment, outcomes, and complications with authoritative, information-based references.
This information base is then used for self-assessment and benchmarking in parts II and IV of the Maintenance of Certification process of the American Board of Plastic Surgery. This article is not intended to be an exhaustive treatise on the subject. Rather, it is designed to serve as a reference point for further in-depth study by review of the reference articles presented.
MOCERT AVAILABLE AT http://www1.plasticsurgery.org/ebusiness4/OnlineCourse/CourseInfo.aspx?Id=14012.
Chapel Hill, N.C.; and Indianapolis, Ind.
From the Division of Plastic Surgery, University of North Carolina, Chapel Hill Medical School, and Division of Plastic Surgery, Indiana University School of Medicine.
Received for publication November 22, 2006; accepted March 2, 2007.
Disclosure: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this article.
The test for the MOC-PS–aligned CME article “Nonsyndromic Cleft Palate” by van Aalst, Kolappa, and Sadove is available at http://www1.plasticsurgery.org/ebusiness4/OnlineCourse/CourseInfo.aspx?Id=14012.
John A. van Aalst, M.D., M.A., Division of Plastic Surgery, University of North Carolina, Chapel Hill, 7033 Burnett-Womack Building, CB 7195, Chapel Hill, N.C., 27599, firstname.lastname@example.org