# Cleft lip and palate

- Category: chronic
- Review status: reviewed (every claim checked against a document named on this page)
- Sources: Cleft Palate - StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK563128/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class DD55.00 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care
- Verified date: 2026-08

## Verified against

- No dose - referral pathway, no medicine given in primary care
- Cleft lip and palate - disease-level clinical article (cleft-lip-palate-full.txt)

## Treatment metadata

- No drug therapy in primary care (Referral & Advice)

## Complete treatment card

```text
CLEFT LIP AND PALATE
Sources: Cleft Palate - StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK563128/ · ICPC-3 (WONCA
         International Classification of Primary Care, 3rd edition) class DD55.00 - condition scope
         only, no dose · No dose - referral pathway, no medicine given in primary care
Review status: REVIEWED against No dose - referral pathway, no medicine given in primary care, Cleft
               lip and palate - disease-level clinical article (cleft-lip-palate-
               full.txt)  (2026-08)

IS IT THIS? - reference only, to read alongside your own examination
  SYMPTOMS - what the patient reports (2)
    - Concomitant cleft palate causes poor feeding and difficulty swallowing, and affects speech
      [difficulty swallowing · poor feeding]
    - Red flag: it usually takes several operations and a whole team, costs a great deal, and leaves
      many of these children with lifelong psychological problems
  SIGNS - what you find (6)
    - Cleft lip can be unilateral or bilateral, and complete or incomplete
    - In bilateral cleft lip, the premaxilla may be pushed forward and need presurgical molding
      before surgery
    - Alveolar clefts should be documented carefully as part of the exam
    - The mildest grade, microform or occult, leaves the lip incompletely separated and the
      vermillion border distorted but not broken
    - The incomplete grade breaks through the vermillion border, often pulling the nostril rim down,
      but the floor of the nose stays intact behind a fibrous Simonart band
    - The complete grade separates the lip and the floor of the nose together
  TESTS (1)
    - Antenatal ultrasound can identify a cleft deformity by the second trimester
  IF NOT THIS - what else fits (2)
    - Acute primary hepatitis stomatitis appears on the differential list
    - Aphthous ulcers, pemphigus, pemphigoid, and erosive lichen planus are also on the differential
      list
  Source  StatPearls "Cleft Lip" - disease-level clinical article
  Status  traced to the source above

1. NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE)    [1st line]
   Adult    Congenital facial anomaly affecting feeding, speech, and hearing; needs a
            multidisciplinary cleft team (plastic surgery, ENT, speech therapy). GP's role is early
            referral and practical feeding advice (special bottles/nipples, upright feeding) while
            awaiting surgery. - Refer, with advice
   Peds     Children follow the same pathway: recognise and refer. No primary-care medicine is
            implied.
   Source   No dose - referral pathway, no medicine given in primary care
   Why      Congenital facial anomaly affecting feeding, speech, and hearing; needs a
            multidisciplinary cleft team (plastic surgery, ENT, speech therapy). GP's role is early
            referral and practical feeding advice (special bottles/nipples, upright feeding) while
            awaiting surgery.
   Caution  No medicine is prescribed for this in primary care - this entry is for recognition and
            referral. Anything given is decided by the service it is referred to.
            RED FLAG - Parents must be taught red flags requiring urgent evaluation, including
            potential for aspiration, choking, airway obstruction, and failure to gain weight.
            RED FLAG - Feeding difficulty or poor weight gain, or other anomalies suggesting an
            associated syndrome: refer for paediatric assessment.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.
```

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