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Cleft lips and palates

Cleft lips and palates:

  • Cleft lip and palate — the third most common congenital abnormality that requires repair at an early age.
  • Associated congenital anomalies are common, especially congenital heart disease.
  • Deglutition and aspiration are common, as are URTI’s and chronic otitis media.
  • Anemia is common due to poor nutrition.
  • Cleft lip repair (cheiloplasty) is performed when infants are 2 to 3 months, but palatoplasty is delayed until infants are 18 months old or older.
  • Occasionally gauze packing needs to be placed in large cavernous cleft palates to keep the laryngoscope from dropping into the cleft during intubation.
  • Midline taping of a RAE tube is preferred.
  • Volatile anesthetic gases are used for maintenance, watch for tube disconnects or occlusions by using CO2 monitoring, lube and tape the eyes, be aware of large doses of injected epinephrine causing arrhythmias.
  • Post-operative airway issues are common. Often the tongue will need to be pulled forward to open occluded airways.

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