Cleft lip and cleft palate

Palate is the barrier between the oral and nasal cavities. It is formed during the embryologic development of the puppy or kitten (ie, before they are born). If this development is interrupted (the cause is mostly unidentified, but usually genetic, or a sequel of certain medications given to the pregnant female, or exposure of the pregnant female to toxins or other teratogens), the newborn puppy or kitten will have palatal defect. The defect can be limited to the lip and/or involve the hard and/or the soft palate and it is usually noticed at an early age (days) of the animal.

Clefts of the lip are usually only of an esthetic significance and if they cause no clinical problems, they do not require treatment. However, clefts of the hard and/or soft palate are usually associated with difficulties nursing, with sneezing, coughing and possibly aspiration pneumonia. Waiting for the surgery requires some efforts for the animal to survive without complications, but the surgery to repair clefts of the hard and/or soft palate is usually necessary if we want to provide the animal good quality of life. If possible, surgery is performed around 3 – 4 months of age of the animal, or upon eruption of all permanent teeth, if the surgery plan requires so.

The first surgery brings the best chances for success, so it needs to be planned carefully and the size and shape of the defect well evaluated. Therefore, computed tomography (CT) of the head (palate) is recommended before attempting any repair.

Large defects may require staging of the repair with removal of the teeth being the first stage in order to gain enough soft tissues for the repair of the defect in the second stage a few weeks later. It is sometimes impossible to surgically repair some really large defects. When repairing defects of the soft palate we should have in mind that even with complete anatomical reconstruction the full function of the soft palate may not be achieved.

As congenital palatal defects are most commonly hereditary, breeding of such animals is highly discouraged and these animals should be neutered. Also, animals with congenital palatal defects may have other congenital anomalies that may become obvious also later in life.

If you have noted any problems with your animal, please consult your veterinarian.

Selected references
1. Fiani N, Verstraete FJ, Arzi B (2016). Reconstruction of Congenital Nose, Cleft Primary Palate, and Lip Disorders. Vet Clin North Am Small Anim Pract;46(4):663-675.
2. Gregory SP (2000). Middle ear disease associated with congenital palatine defects in seven dogs and one cat. J Small Anim Pract;41:398-401.
3. Kaplan JL, Gunther-Harrington CT, Sutton JS, Stern JA (2018). Multiple midline defects identified in a litter of golden retrievers following gestational administration of prednisone and doxycycline: a case series. BMC Vet Res;14(1):86.
4. Kelly KM, Bardach J (2012). Biologic basis of cleft palate and palatal surgery. In: Verstraete FJM, Lommer MJ (eds): Oral and maxillofacial surgery in dogs and cats. Edinburgh, Saunders Elsevier, pp 343-361.
5. Manfra Marretta S (2012). Cleft palate repair techniques. In Verstraete FJM, Lommer MJ (eds): Oral and maxillofacial surgery in dogs and cats. Edinburgh, Saunders Elsevier, pp 351-361.
6. Moura E, Pimpão CT (2017). A numerical classification system for cleft lip and palate in the dog. J Small Anim Pract;58(11):610-614.
7. Nemec A, Daniaux L, Johnson E, Peralta S, Verstraete FJ (2015). Craniomaxillofacial abnormalities in dogs with congenital palatal defects: computed tomographic findings. Vet Surg;44(4):417-422.
8. Peralta S, Fiani N, Kan-Rohrer KH, Verstraete FJM (2017). Morphological evaluation of clefts of the lip, palate, or both in dogs. Am J Vet Res;78(8):926-933.
9. Peralta S, Nemec A, Fiani N, Verstraete FJ (2015). Staged double-layer closure of palatal defects in 6 dogs. Vet Surg;44(4):423-431.
10. Warzee CC, Bellah JR, Richards D (2001). Congenital unilateral cleft of the soft palate in six dogs. J Small Anim Pract;42:338-340.
11. White RN, Hawkins HL, Alemi VP, et al (2009). Soft palate hypoplasia and concurrent middle ear pathology in six dogs. J Small Anim Pract;50:364-372.
12. Wolf ZT, Brand HA, Shaffer JR, et. al (2015). Genome-wide association studies in dogs and humans identify ADAMTS20 as a risk variant for cleft lip and palate. PLoS Genet;11(3):e1005059.