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Also known as: '''''Congenital Oronasal Fistula — Palatoschisis
==Introduction==
| Also known as:
[[File:Cleft lip puppy.jpg|right|thumb|300px|Primary cleft palate with associated cleft lip]]
| '''Congenital oronasal fistula''' <br> '''Palatoschisis'''
[[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.
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.
Possible causes may include administration of [[Antifungal Drugs#Griseofulvin|griseofulvin]] to queens during pregnancy, certain viral infections or ingestion of toxic plants.
[[Image:Cleft-palate.gif|right|thumb|300px|<small><center>A congenital cleft palate defect (Courtesy of Alun Williams (RVC))</center></small>]]
==Aetiology==
The facial part of the dorsal surface of the skull is formed by parts of the [[Skull and Facial Muscles - Anatomy & Physiology|frontal, nasal, maxillary, and incisive bones]]. Problems, such as a cleft palate, can arise if the fusion of these bones does not occur properly. It is also important to note that each quadrant of the skull and jaw develops independent of the other three quadrants. If there is an abnormality on one side, it does not necessarily mean the other side is also affected.
'''Primary cleft palate''': defect between the incisive bone and maxilla. This type of cleft is often associated with a harelip or cleft lip.
'''Secondary cleft palate''': defect in the maxilla that may or may not extend to involve the soft 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.
In some instances [[Anaesthesia|anaesthesia]] may be required to diagnose a soft palate problem.
In some instances [[Anaesthesia|anaesthesia]] may be required to diagnose a soft palate problem.
If a primary palate problem is recognised always check for a secondary palate problem.
If a primary palate problem is recognised always check for a secondary palate problem.
Affected animals often have other concurrent congenital abnormalities and hence a thorough physical exam should be undertaken.
Affected animals often have other concurrent congenital abnormalities and hence a thorough physical exam should be undertaken.
==Laboratory Tests==
===Laboratory Tests===
Often normal unless aspiration pneumonia is present.
Often normal unless aspiration pneumonia is present.
==Radiography==
===Radiography===
Radiographs of the skull are unnecessary however thoracic radiographs are useful to check for the presence of aspiration pneumonia.
Radiographs of the skull are unnecessary however thoracic radiographs are useful to check for the presence of aspiration pneumonia.
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.
Surgical correction is normally only carried out if the defect is small and owners must be warned that more severly affected animals may need multiple procedures.
Surgical correction is normally only carried out if the defect is small and owners must be warned that more severely affected animals may need multiple procedures.
===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===
====Hard palate defects====
====Hard palate defects====
Three procedures have been described firstly, the Lagenbeck or sliding pedicle technique whereby longitudinal strips of mucosa are released from the hard palate and slid together at the midline. Hard palate bone is exposed laterally however granulation and epithelisation occur quickly.
Three procedures have been described firstly, the '''Lagenbeck''' or '''sliding pedicle technique''' whereby longitudinal strips of mucosa are released from the hard palate and slid together at the midline. Hard palate bone is exposed laterally however granulation and epithelisation occur quickly.
The second technique is the Sandwich or overlapping flap technique where by a recipient bed is created by splitting the mucous membrane at the edge of the defect. A donor bed is created by releasing strips of mucosa from the opposite mucous membrane which is then sutured into place.
The second technique is the '''Sandwich''' or '''overlapping flap technique''' where by a recipient bed is created by splitting the mucous membrane at the edge of the defect. A donor bed is created by releasing strips of mucosa from the opposite mucous membrane which is then sutured into place.
Thirdly a combination technique can be applied where both of the above tecniques are used to produce a double layer of mucosa over the cleft.
Thirdly a '''combination technique''' can be applied where both of the above techniques are used to produce a double layer of mucosa over the cleft.
====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.
==Prognosis==
==Prognosis==
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.
{{Learning
|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]
[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]
[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]
}}
==References==
Fossum, T. W. et. al. (2007) '''Small Animal Surgery''' (Third Edition) ''Mosby Elsevier''
Gilson, SD (1998) '''Self-Assessment Colour Review Small Animal Soft Tissue Surgery''' '' Manson''
Merck & Co (2008) '''The Merck Veterinary Manual''' (Eighth Edition) ''Merial''
{{Lisa Milella reviewed
|date = 13 August 2014}}
{{Waltham}}
{{OpenPages}}
[[Category:Nasal Cavity - Developmental Pathology]]
[[Category:Nasal Cavity - Developmental Pathology]]
[[Category:Respiratory System - Developmental Pathology]]
[[Category:Respiratory System - Developmental Pathology]]
[[Category:Cattle]][[Category:Horse]][[Category:Goat]][[Category:Pig]][[Category:Sheep]]
[[Category:Oral Cavity - Developmental Pathology]]
[[Category:Cat]][[Category:Dog]]
[[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:Developmental Dental Conditions]]
[[Category:Lisa Milella reviewed]]
[[Category:Waltham reviewed]]