<prompt> Which of the following is the ideal time for the repair of cleft palate?9-12 months18-24 months2-3 years5-6 years  <response>: Ans. a. 9-12 months Ref: Sabiston 19e p1923-1924; Schwartz 9e p1658-1663: Bailey 26e 634-648, 25e p657-668; Nelson 19e p1252- 1253Ideal time for the repair of cleft palate is 6-18 months of age. Best choice among the given options is 9-12 months.Cleft lip repair is commonly performed between 3 and 6 months of age whereas cleft palate repair is frequently performed between 6 and 18 months. - Bailey 26e 638Surgical closure of a cleft lip is usually performed by 3 months of age. when the infant has shown satisfactory weight gain and is free of any oral, respiratory: or systemic infection. Z-plasty is the most commonly used technique; a staggered suture line minimizes notching of the lip from retraction of scar tissue. The initial repair may be revised at 4 or 5 year of age. In an otherwise healthy child, closure of the palate is usually done before 1 year of age to enhance normal speech development. - Nelson 19e p1252-1253Cleft Lip and PalateClefts of the lip, alveolus and hard and soft palate are the MC congenital abnormalities of the orofacial structuresQ.Frequently occur as isolated deformities but can be associated with other medical conditions, particularly congenital heart diseaseQ.Incomplete clefts affect only a portion of the lip and contain a bridge of tissue connecting the central and lateral lip elements, referred to as Simonarts bandQ.Cleft lip is due to non-fusion of maxillary process with medial nasal processQ.Unilateral cleft lip is associated with posterior displacement of alar cartilageQIncidence:Highest incidence reported for cleft lip and palate occurs in the Indian tribes of Montana, USA 1:276.Cleft lippalate predominates in malesQCleft palate alone appears to be more common in femalesQ.Incidence of cleft lip and palate is 1:600 live birthsQIncidence of isolated cleft palate is 1:1000 live birthsQDistribution:In unilateral cleft lip the deformity affects the left sideQ in 60 of cases.Typical distribution of cleft typesCleft lip alone: 15Cleft lip and palate: 45 MCQIsolated cleft palate: 40Etiology of cleft lip and palateEtiology of cleft lip and palate: Genetic predisposition and a contributory environmental componentQ. Environmental factors: Maternal epilepsyQ and drugs steroids, diazepam and phenytoinQ.Associated syndromes:Although most clefts of the lip and palate occur as an isolated deformity, Pierre Robin sequence remains the most common syndromeQ.Other associated syndromes: Sticklers ophthalmic and musculoskeletal abnormalities, Shprintzens cardiac anomalies, Downs, Aperts and Treacher-Collinssyndromes.Types of Cleft lipTypes of Cleft palate Unilateral deft lip Bilateral deft lip Incomplete: Cleft of the hard palate remains attached to the nasal septum and vomerQ Complete: Nasal septum and vomer are completely separated from the palatine processesQAntenatal diagnosis:All but isolated cleft palate can be diagnosed by ultrasound after 18 weeksQ gestationProblems immediately after birth:Some babies are able to feed normally but some will need assistanceBreathing problems in Pierre Robin sequence may be life threateningManagement:Surgical techniques are aimed at restoring normal anatomy.Cleft lip Repaired between 3-6 months of ageQCleft palate Repaired between 6-18 months of ageQPrinciples of surgery:Cleft lip surgery attaches and reconnects the muscles around the oral sphincterQCleft palate surgery aims to bring together mucosa and muscles with minimal scarringQTwo-stage procedures attempt to minimize dissectionQSecondary Management:Following primary surgery, regular review by a multidisciplinary team is essentialQ.Many aspects of cleft care require long-term review: Hearing, speech, dental development, facial growthQ.Timing of Primary Cleft Lip and Palate Procedures after DelaireCleft lip aloneCleft palate aloneCleft lip and palate Unilateral one side: One operation at 5-6 months Bilateral both sides: One operation at 4-5 months Soft palate only: One operation at 6 monthsQ Soft and hard palate: Two operations- Soft palate at 6 monthsQ - Hard palate at 15-18 months Unilateral: Two operations- Cleft lip and soft palate at 5-6 months- Hard palate and gum pad with or without lip revision at 15-18 months Bilateral: Two operations- Cleft lip and soft palate at 4-5 months- Hard palate and gum pad with or without lip revision at 15-18 months 