This article reviews clefts involving the lip with or without the palate (CLPϮP) and isolated clefts of the palate (CP) from genetic and epidemiologic perspectives. Particular attention is given to management strategies to address issues arising in the neonatal period before the deformity is treated. The multidisciplinary team is especially important in tailoring care to the needs of the child. Regional specialist services are recommended during early childhood for infants who have CLPϮP or CP.Objectives After completing this article, readers should be able to: 1. Discuss aberrant orofacial development in cleft lip and palate. 2. Describe known genetic and environmental contributing factors to the development of nonsyndromic cleft lip and palate. 3. Discuss how to tailor care of the preterm infant to the presence of an untreated cleft lip or palate deformity. 4. Delineate the functional impact of cleft lip or palate on feeding, tooth development, and speech and language.
Understanding of the impact of disordered palatal and orofacial development on preterm neonatal survivors is increasing. Optimal clinical assessment and management requires neonatologists to have a sound knowledge of: normal palatal development; potential causes for disordered development, including iatrogenic causes; factors to assess on newborn examination; and optimal multidisciplinary follow-up for feeding, orthodontic, and speech-language development. Key findings quantify harmful effects of intubation on palatal shape, tooth eruption/morphology, and speech; further studies are required to delineate the effect on swallowing. The evidence base is discussed for preterm care and palatal and orofacial development in preterm and low-birthweight infants. Current knowledge is limited by lack of uniformity of definition and measurement tools. Guidance is summarized for practical management and follow-up of preterm and low-birthweight infants requiring intubation.Objectives After completing this article, readers should be able to:1. Describe normal palatal development. Describe potential alterations in palatal morphology and orofacial development amongpreterm infants compared with term infants. 3. Discuss the contributing role of oral intubation to palatal development. 4. Manage the functional impact on feeding, tooth development, and speech and language of disordered palatal development.
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