Unilateral Cleft Nasal Repair Workup

Updated: Feb 24, 2020
  • Author: Mimi T Chao, MD; Chief Editor: Jorge I de la Torre, MD, FACS  more...
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Workup

Laboratory Studies

The rule of 10 is the long-standing guideline to determine when a neonate is fit for surgical repair. [59] This rule mandates that the infant weigh at least 10 lb, be aged at least 10 weeks, and have a minimum hemoglobin level of 10 g/dL before surgery is considered. This rule has often excluded neonates younger than 28 days. However, new advances in neonatal anesthesia have made surgery possible in those excluded by these guidelines.

Hemoglobin studies, hematocrit studies, and platelet counts are routinely obtained, and the neonate is evaluated by the appropriate anesthesia team. Any cardiac or respiratory problems are addressed prior to surgery with the appropriate referrals made, as needed.

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Imaging Studies

Cleft lip can be diagnosed prenatal with ultrasonography as early as 20 weeks. A prenatal ultrasound diagnosis should be followed promptly with a consultation with a multidisciplinary cleft team for parent counseling and discussion of expectations. Parents should be advised that while ultrasound technology continues to be more refined, it can underestimate the degree of actual clefting.

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Other Tests

Genetics consultation and workup should be considered in all patients with cleft lip and nose. It is especially important if the patient has other anomalies or has a family history of clefting.

Cleft lip and nose are often associated with clefting of the palate. These children often have difficulties with sucking, feeding, and weight gain that require evaluation by a feeding specialist; they may need special bottles and nipples.

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