Cleft lip and palate — branching viva

Branch 1 — The classification, the embryology and the feeding

The candidate should classify the cleft as Veau grade III (unilateral cleft lip and palate) and explain the embryology: the cleft lip arose from failure of fusion of the medial nasal prominence (frontonasal process) with the maxillary process on the left around week six, and the cleft palate arose from failure of the palatal shelves to fuse in the midline between weeks nine and twelve. The lip forms before the palate, which is why both are affected together. ^{[1] [2]}

Probe the feeding: the candidate should explain that the cleft palate breaks the oral-nasal seal so the infant cannot generate negative intraoral suction for a standard nipple or the breast, and that the correct technique is an upright position with a squeeze bottle (Haberman or Pigeon teat) delivering milk by compression, with paced feeding and frequent burping. Push on the consequence of a standard bottle — nasal regurgitation, choking, aspiration, prolonged feeding and failure to thrive. ^[7]