Reducing delayed detection of isolated cleft palate-related deformity: a call for routine intraoral examination of newborns

Abstract

Objective: To provide healthcare professional-friendly practical recommendations for early detection of cleft palate-related deformities in newborns and offer an overview of managing these high-prevalent congenital abnormalities.

Source of data: PubMed, SciELO, Lilacs, Cochrane, ScienceDirect, and Scopus databases were reviewed for cleft- and diagnosis-related studies.

Summary of the findings: Unfortunately, the global prevalence of delayed detection of cleft palate-related deformities remains unacceptably high, with over a quarter of cleft palates missed at birth. This delayed identification causes physical and psychological distress for patients and families, including feeding challenges and weight faltering. To improve cleft management, it is essential to adopt routine detailed, in-depth intraoral examination immediately after birth. It is recommended not only to finger-assisted palpate the intraoral structures but also to visually inspect the oral cavity from gingiva to uvula using a wooden tongue depressor and light-assisted examination. With timely diagnosis and referral to specialized care, pediatricians, nurses, speech therapists, and plastic surgeons provide life-changing treatments, including health care maintenance, anticipatory guidance, feeding support, primary surgical reconstruction, and age- and condition-specific protocols.

Conclusions: Encouraging neonatologists and pediatricians, who are the first to examine newborns, to actively investigate the intraoral region for cleft palate-related deformities is instrumental in optimizing therapeutic approaches and prioritizing age-phases in treatment. Their crucial role in early detection and referral can lead to transformative outcomes, impacting not only the future of the newborns by facilitating functional integration into society but also yielding positive effects on families and the health system.

Keywords: Cleft; Cleft care; Cleft palate; Delay; Diagnosis; Palatoplasty; Referral.

Figure. 1

(Left) Schematic drawings illustrating cleft palate deformities, encompassing instances featuring (Left, top) solely the soft palate, (Left, bottom) both the soft and hard palates, and (Right) an overt submucous cleft palate deformity. These deformities are categorized using Noordhoff's modified double-numbered Y classification system. Courtesy of Rafael Denadai, M.D.

Figure. 2

Schematic drawings illustrating the (Left) normal anatomy of the palate and (Right) the abnormal anatomy in an isolated cleft palate deformity. (Right) The cleft muscle mass (including the levator muscle) runs almost parallel with the cleft margin before it inserts aberrantly into the posterior border of the hard palate. The anterior tendinous fibers of the tensor attach to the lateral aspect of the posterior edge of the hard palate. The aberrant positioning of the cleft muscle mass, along with an abnormal fusion with the tendon of the tensor muscle, is believed to impair the function of the tensor muscle in assisting with Eustachian tube function. The aberrantly inserted cleft muscle mass results in ineffective contraction and an inability to close the palate against the posterior pharyngeal wall. Courtesy of Rafael Denadai, M.D.

Figure. 3

Intraoral images displaying the spectrum of isolated cleft palate deformity, highlighted by a gray arrow to indicate the escalating severity of abnormalities. Tongue depressors assist in gently retracting the tongue, providing a broader intraoral view. Simultaneously, direct lighting helps to illuminate the intraoral space, ensuring adequate brightness and contrast to observe the specific details of the palatal structures. Courtesy of Rafael Denadai, M.D.