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Also known as: '''''Congenital oronasal fistula — Palatoschisis

 

[[File:Cleft lip puppy.jpg|right|thumb|300px|Primary cleft palate with associated cleft lip]]

[[Image:Cleft-palate.gif|right|thumb|300px|<small><center>A congenital cleft palate defect (Courtesy of Alun Williams (RVC))</center></small>]]

[[File:Cleft palate 2.jpg|right|thumb|300px|Secondary cleft palate]]

An abnormal communication between the [[Nasal Cavity - Anatomy & Physiology| nasal]] and [[Oropharynx - Anatomy & Physiology| oral]] cavities involving the [[Soft Palate| soft palate]] , [[Hard Palate| hard palate]], premaxilla and or [[Lips|lip]] . Abnormalities arise during foetal development where there is incomplete closure of the primary palate, secondary palate or both.  

An abnormal communication between the [[Nasal Cavity - Anatomy & Physiology| nasal]] and [[Oropharynx - Anatomy & Physiology| oral]] cavities involving the [[Soft Palate| soft palate]] , [[Hard Palate| hard palate]], premaxilla and or [[Lips|lip]] . Abnormalities arise during foetal development where there is incomplete closure of the primary palate, secondary palate or both.  

The primary palate develops into the premaxilla and lip. If closure is not complete this will result in a primary palate or cleft lip (harelip).

The primary palate develops into the premaxilla and lip. If closure is not complete this will result in a primary palate or cleft lip (harelip).

The secondary palate forms the hard and soft palate and incomplete closure of either of these results in a secondary palate or cleft palate.

The secondary palate forms the hard and soft palate and incomplete closure of either of these results in a secondary palate or cleft palate.

==Signalment==

==Signalment==

Dogs are more commonly affected than cats. In particular brachycephalic breeds are more commonly affected due to the intra-uterine growth characteristics of the skull. Other at risk [[Canine Breeds - WikiNormals| dog breeds]] include, Boston terriers, Pekingese, minature schnauzers, beagles and cocker spaniels.

Dogs are more commonly affected than cats. In particular brachycephalic breeds are more commonly affected due to the intra-uterine growth characteristics of the skull. Other at risk [[Canine Breeds - WikiNormals| dog breeds]] include, Boston Terriers, Pekingese, Minature Schnauzers, Beagles and Cocker Spaniels.

Siamese are the most commonly affected [[Feline Breeds - WikiNormals|cat breed]].

Siamese are the most commonly affected [[Feline Breeds - WikiNormals|cat breed]].

Present at birth but not always noticed straight away.

Present at birth but not always noticed straight away.

==Diagnosis==

==Diagnosis==

===History and Clinical Signs===

===History and Clinical Signs===

Failure to thrive with signs such as nasal discharge, nasal milk regurgitation, gagging, coughing or sneezing during nursing, and respiratory infection due to aspiration pneumonia or rhinitis.  

Failure to thrive with signs such as nasal discharge, nasal milk regurgitation, halitosis, gagging, coughing or sneezing during nursing, and respiratory infection due to aspiration pneumonia or rhinitis.  

Diagnosis is made on physical exam. A cleft lip can be easily identified, however, a full oral examination is needed to diagnose incomplete closure of the premaxilla, hard and soft palate.

Diagnosis is made on physical exam. A cleft lip can be easily identified, however, a full oral examination is needed to diagnose incomplete closure of the premaxilla, hard and soft palate.

A large proportion of animals with primary or secondary palate defects die or are euthanased. In some cases however the defects can be managed medically until the patient is old enough for surgery.

A large proportion of animals with primary or secondary palate defects die or are euthanased. In some cases however the defects can be managed medically until the patient is old enough for surgery.

Affected animals should gain nutritional support via a feeding tube to avoid aspiration pneumonia until surgery can be undertaken.

Affected animals should gain nutritional support via a feeding tube to avoid [[Aspiration Pneumonia|aspiration pneumonia]] until surgery can be undertaken.

Aspiration pneumonia should also be treated with appropriate antibiotics, expectorants and oxygen.

Aspiration pneumonia should also be treated with appropriate antibiotics, expectorants and oxygen.

Surgery should be delayed until the animal is 12-14 weeks old or longer if possible in order to get the best possible post surgical outcome. More mature tissue is less friable and holds suture better.   

Surgery should be delayed until the animal is 12-14 weeks old or longer if possible in order to get the best possible post surgical outcome. More mature tissue is less friable and holds suture better.   

===Closure of Primary Clefts===

===Closure of Primary Clefts===

Often very difficult to correct surgically, and requires planning and multiple surgeries.

Often very difficult to correct surgically, and requires planning and often multiple surgeries.

===Closure of Secondary Clefts===

===Closure of Secondary Clefts===

====Soft Palate defects====

====Soft Palate defects====

An overlapping flap technique, flaps from the hard palate and nasopharangeal mucosa flaps can be used to repair soft palate deformities.

An overlapping flap technique, flaps from the hard palate and nasopharangeal mucosa flaps can be used to repair soft palate deformities. It is important to reduce tension on suture lines, preserve the connective tissue and vascular supply and have good apposition of tissue to promote rapid healing of the wound.  

Post operatively patients should be fed via a tube to prevent trauma to the surgical site and to maintain nutritional intake. Dehiscence and recurrence can occur following movement, tension and growth.

Post operatively patients should be fed via a tube to prevent trauma to the surgical site and to maintain nutritional intake. Dehiscence and recurrence can occur following movement, tension and growth.

Historically, surgical correction of these conditions had a low success rate. More recently new surgical techniques can result in a good prognosis, however, multiple surgeries may be required and aspiration pneumonia must be treated.

Historically, surgical correction of these conditions had a low success rate. More recently new surgical techniques can result in a good prognosis, however, multiple surgeries may be required and aspiration pneumonia must be treated.

==Test yourself with the Oral Cavity Pathology Flashcards==

|Vetstream = [https://www.vetstream.com/canis/Content/Disease/dis00692.asp, Harelip]<br>[https://www.vetstream.com/canis/Content/Disease/dis00691.asp, Cleft lip and palate]<br>[https://www.vetstream.com/canis/Content/Technique/teq00674.asp, Cleft palate repair]

|flashcards = [[Oral_Cavity_Flashcards_-_Pathology|Oral Cavity Pathology Flashcards]]<br>[[Small Animal Soft Tissue Surgery Q&A 01]]

|literature search = [http://www.cabdirect.org/search.html?start=0&q=%28%28od%3A%28dogs%29%29%29+AND+%28%28title%3A%28%22Cleft+Palate%22%29%29%29 Cleft palate in Dogs publications]

[[Oral_Cavity_Flashcards_-_Pathology|Oral Cavity Pathology Flashcards]]

[http://www.cabdirect.org/search.html?q=%28%28od%3A%28horses%29%29%29+AND+%28%28title%3A%28%22Cleft+Palate%22%29%29%29 Cleft palate in Horses publications]

[http://www.cabdirect.org/search.html?q=%28%28od%3A%28cats%29%29%29+AND+%28%28title%3A%28%22Cleft+Palate%22%29%29%29 Cleft palate in Cats publications]

[[File:CABI logo.jpg|left|90px]]

Use these links to find recent scientific publications via CAB Abstracts (log in required unless accessing from a subscribing organisation).

Fossum, T. W. et. al. (2007) '''Small Animal Surgery''' (Third Edition) ''Mosby Elsevier''

[http://www.cabdirect.org/search.html?start=0&q=%28%28od%3A%28dogs%29%29%29+AND+%28%28title%3A%28%22Cleft+Palate%22%29%29%29 Cleft palate in Dogs publications]

 

 

Merck & Co (2008) '''The Merck Veterinary Manual''' (Eighth Edition) ''Merial''

[http://www.cabdirect.org/search.html?q=%28%28od%3A%28cattle%29+OR+od%3A%28sheep%29+OR+od%3A%28goats%29%29%29+AND+%28%28title%3A%28%22Cleft+Palate%22%29%29%29 Cleft palate in Farm Animals publications]

|date = 13 August 2014}}

[[Category:Nasal Cavity - Developmental Pathology]]

[[Category:Nasal Cavity - Developmental Pathology]]

[[Category:Respiratory System - Developmental Pathology]]

[[Category:Respiratory System - Developmental Pathology]]

[[Category:Oral Cavity - Developmental Pathology]]

[[Category:Oral Cavity - Developmental Pathology]]

[[Category:Cattle]][[Category:Oral Disorders - Horse]][[Category:Goat]][[Category:Pig]][[Category:Sheep]]

[[Category:Oral Diseases - Cattle]][[Category:Oral Diseases - Horse]][[Category:Oral Diseases - Goat]][[Category:Oral Diseases - Pig]][[Category:Oral Diseases - Sheep]]

[[Category:Oral Diseases - Cat]][[Category:Oral Diseases - Dog]]

[[Category:Oral Diseases - Cat]][[Category:Oral Diseases - Dog]]

[[Category:Expert_Review]]

[[Category:Developmental Dental Conditions]]

[[Category:Waltham reviewed]]