Sleep Medicine Reviews
Volume 13, Issue 5 , Pages 345-354 , October 2009

Cleft lip and/or palate and breathing during sleep

  • Joanna E. MacLean

      Affiliations

    • Discipline of Paediatrics & Child Health, Faculty of Medicine, University of Sydney, NSW, Australia
    • Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia
    • Corresponding Author InformationCorresponding author at: Department of Respiratory Medicine, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, Australia. Tel.: +61 2 9845 0000; fax: +61 2 9845 3633.
    • ,
  • Peter Hayward

      Affiliations

    • Department of Plastic Surgery, The Children's Hospital at Westmead, Sydney, NSW, Australia
    • ,
  • Dominic A. Fitzgerald

      Affiliations

    • Discipline of Paediatrics & Child Health, Faculty of Medicine, University of Sydney, NSW, Australia
    • Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia
    • ,
  • Karen Waters

      Affiliations

    • Discipline of Paediatrics & Child Health, Faculty of Medicine, University of Sydney, NSW, Australia
    • Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia

References* 

  1. Hewson AR, McNamara CM. Cleft lip and/or palate in the west of Ireland, 1980–1996. Spec Care Dentist. 2000;20(4):143–146
  2. Vallino-Napoli LD, Riley MM, Halliday J. An epidemiologic study of isolated cleft lip, palate, or both in Victoria, Australia from 1983 to 2000. Cleft Palate Craniofac J. 2004;41(2):185–194
  3. Gundlach KK, Maus C. Epidemiological studies on the frequency of clefts in Europe and world-wide. J Craniomaxillofac Surg. 2006;34(Suppl. 2):1–2
  4. Calzolari E, Pierini A, Astolfi G, Bianchi F, Neville AJ, Rivieri F. Associated anomalies in multi-malformed infants with cleft lip and palate: an epidemiologic study of nearly 6 million births in 23 EUROCAT registries. Am J Med Genet A. 2007;143(6):528–537
  5. Eppley BL, van Aalst JA, Robey A, Havlik RJ, Sadove AM. The spectrum of orofacial clefting. Plast Reconstr Surg. 2005;115(7):101e–114e
  6. Veau V. Division palantine. Paris: Masson et Cie; 1931;
  7. Koch H, Grzonka M, Koch J. Cleft malformation of lip, alveolus, hard and soft palate, and nose (LAHSN) – a critical view of the terminology, the diagnosis and gradation as a basis for documentation and therapy. British Journal of Oral & Maxillofacial Surgery. 1995;33(1):51–58
  8. Harkins CS, Berlin A, Harding RL, Longacre JJ, Snodgrasse RM. A classification of cleft lip and cleft palate. Plast Reconstr Surg. 1962;29:31–39
  9. Stoll C, Alembik Y, Dott B, Roth MP. Associated malformations in cases with oral clefts. Cleft Palate Craniofac J. 2000;37(1):41–47
  10. Kallen B, Harris J, Robert E. The epidemiology of orofacial clefts. 2. Associated malformations. Journal of Craniofacial Genetics & Developmental Biology. 1996;16(4):242–248
  11. Reid J, Kilpatrick N, Reilly S. A prospective, longitudinal study of feeding skills in a cohort of babies with cleft conditions. Cleft Palate Craniofac J. 2006;43(6):702–709
  12. Pandya AN, Boorman JG. Failure to thrive in babies with cleft lip and palate. Br J Plast Surg. 2001;54(6):471–475
  13. Lipman TH, Rezvani I, Mitra A, Mastropieri CJ. Assessment of stature in children with orofacial clefting. MCN, American Journal of Maternal Child Nursing. 1999;24(5):252–256
  14. Lee J, Nunn J, Wright C. Height and weight achievement in cleft lip and palate. Arch Dis Child. 1997;76(1):70–72
  15. Laitinen S, Heliovaara A, Pere A, Ranta R. Growth in children with Pierre Robin sequence and isolated cleft palate. Acta Paediatr. 1994;83(11):1161–1164
  16. Chapman KL, Hardin-Jones M, Halter KA. The relationship between early speech and later speech and language performance for children with cleft lip and palate. Clin Linguist Phon. 2003;17(3):173–197
  17. Hutters B, Henningsson G. Speech outcome following treatment in cross-linguistic cleft palate studies: methodological implications. Cleft Palate Craniofac J. 2004;41(5):544–549
  18. Peterson-Falzone SJ. Speech outcomes in adolescents with cleft lip and palate. Cleft Palate Craniofac J. 1995;32(2):125–128
  19. Neiman GS, Savage HE. Development of infants and toddlers with clefts from birth to three years of age. Cleft Palate Craniofac J. 1997;34(3):218–225
  20. Swanenburg d V, Beemer FA, Mellenbergh GJ, Wolters WH, Heineman-de Boer JA. An investigation of the relationship between associated congenital malformations and the mental and psychomotor development of children with clefts. Cleft Palate Craniofac J. 2003;40(3):297–303
  21. Kapp-Simon KA, Krueckeberg S. Mental development in infants with cleft lip and/or palate. Cleft Palate Craniofac J. 2000;37(1):65–70
  22. Robin P. A fall of the base of the tongue considered as a new cause of nasopharyngeal respiratory impairment: Pierre Robin sequence, a translation. 1923. Plast Reconstr Surg. 1994;93(6):1301–1303
  23. Holder-Espinasse M, Abadie V, Cormier-Daire V, Beyler C, Manach Y, Munnich A, et al. Pierre Robin sequence: a series of 117 consecutive cases. J Pediatr. 2001;139(4):588–590
  24. Li HY, Lo LJ, Chen KS, Wong KS, Chang KP. Robin sequence: review of treatment modalities for airway obstruction in 110 cases. Int J Pediatr Otorhinolaryngol. 2002;65(1):45–51
  25. van den Elzen AP, Semmekrot BA, Bongers EM, Huygen PL, Marres HA. Diagnosis and treatment of the Pierre Robin sequence: results of a retrospective clinical study and review of the literature. Eur J Pediatr. 2001;160(1):47–53
  26. Rohrich RJ, Rowsell AR, Johns DF, Drury MA, Grieg G, Watson DJ, et al. Timing of hard palatal closure: a critical long-term analysis. Plast Reconstr Surg. 1996;98(2):236–246
  27. Friede H, Enemark H. Long-term evidence for favorable midfacial growth after delayed hard palate repair in UCLP patients. Cleft Palate Craniofac J. 2001;38(4):323–329
  28. Liao YF, Mars M. Hard palate repair timing and facial growth in cleft lip and palate: a systematic review. Cleft Palate Craniofac J. 2006;43(5):563–570
  29. Cleft palate speech. 2nd ed.. Philadelphia: BC Decker; 1990;
  30. Timmons MJ, Wyatt RA, Murphy T. Speech after repair of isolated cleft palate and cleft lip and palate. Br J Plast Surg. 2001;54(5):377–384
  31. Phua YS, de CT. Incidence of oronasal fistulae and velopharyngeal insufficiency after cleft palate repair: an audit of 211 children born between 1990 and 2004. Cleft Palate Craniofac J. 2008;45(2):172–178
  32. Bicknell S, McFadden LR, Curran JB. Frequency of pharyngoplasty after primary repair of cleft palate. Journal (Canadian Dental Association). 2002;68(11):688–692
  33. DeLuke DM, Marchand A, Robles EC, Fox P. Facial growth and the need for orthognathic surgery after cleft palate repair: literature review and report of 28 cases. Journal of Oral & Maxillofacial Surgery. 1997;55(7):694–697
  34. Scheuer HA, Holtje WJ, Hasund A, Pfeifer G. Prognosis of facial growth in patients with unilateral complete clefts of the lip, alveolus and palate. J Craniomaxillofac Surg. 2001;29(4):198–204
  35. Cheung LK, Chua HD. A meta-analysis of cleft maxillary osteotomy and distraction osteogenesis. Int J Oral Maxillofac Surg. 2006;35(1):14–24
  36. Kadowaki S, Sakamoto M, Kamiishi H, Tanimura T. Embryologic features of term fetuses and newborns in CL/Fr mice with special reference to cyanosis. Cleft Palate Craniofac J. 1997;34(3):211–217
  37. Hermann NV, Kreiborg S, Darvann TA, Jensen BL, Dahl E, Bolund S. Early craniofacial morphology and growth in children with unoperated isolated cleft palate. Cleft Palate Craniofac J. 2002;39(6):604–622
  38. Kilpelainen PV, Laine-Alava MT, Lammi S. Palatal morphology and type of clefting. Cleft Palate Craniofac J. 1996;33(6):477–482
  39. Rose E, Thissen U, Otten JE, Jonas I. Cephalometric assessment of the posterior airway space in patients with cleft palate after palatoplasty. Cleft Palate Craniofac J. 2003;40(5):498–503
  40. Rustemeyer J, Thieme V, Bremerich A. Snoring in cleft patients with velopharyngoplasty. Int J Oral Maxillofac Surg. 2008;37(1):17–20
  41. Smahel Z, Mullerova I. Nasopharyngeal characteristics in children with cleft lip and palate. Cleft Palate Craniofac J. 1992;29(3):282–286
  42. Fukushiro AP, Trindade IE. Nasal airway dimensions of adults with cleft lip and palate: differences among cleft types. Cleft Palate Craniofac J. 2005;42(4):396–402
  43. Kunkel M, Wahlmann U, Wagner W. Acoustic airway profiles in unilateral cleft palate patients. Cleft Palate Craniofac J. 1999;36(5):434–440
  44. Wahlmam U, Kunkel M, Wagner W. Preoperative assessment of airway patency in the planning of corrective cleft nose surgery. Mund Kiefer Gesichtschir. 1998;2(Suppl. 7):
  45. Kunkel M, Wahlmann U, Wagner W. Nasal airway in cleft-palate patients: acoustic rhinometric data. J Craniomaxillofac Surg. 1997;25(5):270–274
  46. Grossmann N, Brin I, Aizenbud D, Sichel JY, Gross-Isseroff R, Steiner J. Nasal airflow and olfactory function after the repair of cleft palate (with and without cleft lip). Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;100(5):539–544
  47. Kunkel M, Wahlmann U, Wagner W. Objective, noninvasive evaluation of velopharyngeal function in cleft and noncleft patients. Cleft Palate Craniofac J. 1998;35(1):35–39
  48. Igawa HH, Nishizawa N, Sugihara T, Inuyama Y. A fiberscopic analysis of velopharyngeal movement before and after primary palatoplasty in cleft palate infants. Plast Reconstr Surg. 1998;102(3):668–674
  49. Williams WN, Bzoch KR, xon-Wood V, Seagle MB, Nackashi JA, Marks RG, et al. Velopharyngeal function for speech after the Frolova primary palatoplasty technique. Cleft Palate Craniofac J. 1998;35(6):481–488
  50. Nagaoka K, Tanne K. Activities of the muscles involved in swallowing in patients with cleft lip and palate. Dysphagia. 2007;22(2):140–144
  51. Mortimore IL, Douglas NJ. Palatal muscle EMG response to negative pressure in awake sleep apneic and control subjects. Am J Respir Crit Care Med. 1997;156(3 Pt 1):867–873
  52. Malhotra A, Trinder J, Fogel R, Stanchina M, Patel SR, Schory K, et al. Postural effects on pharyngeal protective reflex mechanisms. Sleep. 2004;27(6):1105–1112
  53. Koizumi H, Kogo M, Matsuya T. Coordination between palatal and laryngeal muscle activities in response to rebreathing and lung inflation. Cleft Palate Craniofac J. 1996;33(6):459–462
  54. Oosterkamp BC, Remmelink HJ, Pruim GJ, Hoekema A, Dijkstra PU. Craniofacial, craniocervical, and pharyngeal morphology in bilateral cleft lip and palate and obstructive sleep apnea patients. Cleft Palate Craniofac J. 2007;44(1):1–7
  55. Muntz H, Wilson M, Park A, Smith M, Grimmer JF. Sleep disordered breathing and obstructive sleep apnea in the cleft population. Laryngoscope. 2008;118(2):348–353
  56. MacLean JE, Fitzsimons D, Hayward P, Waters KA, Fitzgerald DA. The identification of children with cleft palate and sleep disordered breathing using a referral system. Pediatr Pulmonol. 2008;43(3):245–250
  57. MacLean JE, Fitzsimons D, Hayward P, Waters KA, Fitzgerald DA. Screening for obstructive sleep apnoea in pre-school children with cleft palate. Cleft Palate Craniofac J. 2009;46(2):117–123
  58. Wilson AC, Moore DJ, Moore MH, Martin AJ, Staugas REM, Kennedy JD. Late presentation of upper airway obstruction in Pierre Robin sequence. Arch Dis Child. 2000;83:435–438
  59. Spier S, Rivlin J, Rowe RD, Egan T. Sleep in Pierre Robin syndrome. Chest. 1986;90(5):711–715
  60. Gilhooly JT, Smith JD, Howell LL, Deschaine BL, Richey SL. Bedside polysomnography as an adjunct in the management of infants with Robin sequence. Plast Reconstr Surg. 1993;92(1):23–27
  61. Josephson GD, Levine J, Cutting CB. Septoplasty for obstructive sleep apnea in infants after cleft lip repair. Cleft Palate Craniofac J. 1996;33(6):473–476
  62. Liao YF, Noordhoff MS, Huang CS, Chen PK, Chen NH, Yun C, et al. Comparison of obstructive sleep apnea syndrome in children with cleft palate following Furlow palatoplasty or pharyngeal flap for velopharyngeal insufficiency. Cleft Palate Craniofac J. 2004;41(2):152–156
  63. Orr WC, Levine NS, Buchanan RT. Effect of cleft palate repair and pharyngeal flap surgery on upper airway obstruction during sleep. Plast Reconstr Surg. 1987;80(2):226–232
  64. Rose E, Staats R, Thissen U, Otten JE, Schmelzeisen R, Jonas I. Sleep-related obstructive disordered breathing in cleft palate patients after palatoplasty. Plast Reconstr Surg. 2002;110(2):392–396
  65. Liao YF, Yun C, Huang CS, Chen PK, Chen NH, Hung KF, et al. Longitudinal follow-up of obstructive sleep apnea following Furlow palatoplasty in children with cleft palate: a preliminary report. Cleft Palate Craniofac J. 2003;40(3):269–273
  66. Antony A, Sloan GM. Airway obstruction following palatoplasty: analysis of 247 consecutive operations. Cleft Palate Craniofac J. 2002;39(2):145–148
  67. Lin KY, Goldberg D, Williams C, Borowitz K, Persing J, Edgerton M. Long-term outcome analysis of two treatment methods for cleft palate: combined levator retropositioning and pharyngeal flap versus double-opposing Z-plasty. Cleft Palate Craniofac J. 1999;36(1):73–78
  68. Sirois M, Caouette-Laberge L, Spier S, Larocque Y, Egerszegi EP. Sleep apnea following a pharyngeal flap: a feared complication. Plast Reconstr Surg. 1994;93(5):943–947
  69. Abramson DL, Marrinan EM, Mulliken JB. Robin sequence: obstructive sleep apnea following pharyngeal flap. Cleft Palate Craniofac J. 1997;34(3):256–260
  70. Liao YF, Chuang ML, Chen PK, Chen NH, Yun C, Huang CS. Incidence and severity of obstructive sleep apnea following pharyngeal flap surgery in patients with cleft palate. Cleft Palate Craniofac J. 2002;39(3):312–316
  71. Ysunza A, Garcia-Velasco M, Garcia-Garcia M, Haro R, Valencia M. Obstructive sleep apnea secondary to surgery for velopharyngeal insufficiency. Cleft Palate Craniofac J. 1993;30(4):387–390
  72. Wells MDM, Vu TAM, Luce EAM. Incidence and sequelae of nocturnal respiratory obstruction following posterior pharyngeal flap operation. Ann Plast Surg. 1999;43(3):252–257
  73. Lesavoy MAM, Borud LJM, Thorson T, Riegelhuth ME, Berkowitz CDM. Upper airway obstruction after pharyngeal flap surgery. Ann Plast Surg. 1996;36(1):26–32
  74. Cole P, Banerji S, Hollier L, Stal S. Two hundred twenty-two consecutive pharyngeal flaps: an analysis of postoperative complications. Journal of Oral & Maxillofacial Surgery. 2008;66(4):745–748
  75. Jackson P, Whitaker LA, Randall P. Airway hazards associated with pharyngeal flaps in patients who have the Pierre Robin syndrome. Plast Reconstr Surg. 1976;58(2):184–186
  76. Kravath RE, Pollak CP, Borowiecki B, Weitzman ED. Obstructive sleep apnea and death associated with surgical correction of velopharyngeal incompetence. J Pediatr. 1980;96(4):645–648
  77. Robson MC, Stankiewicz JA, Mendelsohn JS. Cor pulmonale secondary to cleft palate repair. Case report. Plast Reconstr Surg. 1977;59(5):754–757
  78. Abyholm F, D'Antonio L, vidson Ward SL, Kjoll L, Saeed M, Shaw W, et al. Pharyngeal flap and sphincterplasty for velopharyngeal insufficiency have equal outcome at 1 year postoperatively: results of a randomized trial. Cleft Palate Craniofac J. 2005;42(5):501–511
  79. Saint RC, Bettega G, Deschaux C, Lebeau J, Raphael B, Levy P, et al. Sphincter pharyngoplasty as a treatment of velopharyngeal incompetence in young people: a prospective evaluation of effects on sleep structure and sleep respiratory disturbances. Chest. 2004;125(3):864–871
  80. de Serres LM, Deleyiannis FW, Eblen LE, Gruss JS, Richardson MA, Sie KC. Results with sphincter pharyngoplasty and pharyngeal flap. Int J Pediatr Otorhinolaryngol. 1999;48(1):17–25
  81. Iida S, Kogo M, Ishii S, Kohara H, Matsuya T. Changes of arterial oxygen saturation (SpO2) following push-back operation. International Journal of Oral & Maxillofacial Surgery. 1998;27(6):425–427
  82. Lidsky ME, Lander TA, Sidman JD. Resolving feeding difficulties with early airway intervention in Pierre Robin Sequence. Laryngoscope. 2008;118(1):120–123
  83. Caouette-Laberge L, Bayet B, Larocque Y. The Pierre Robin sequence: review of 125 cases and evolution of treatment modalities. Plast Reconstr Surg. 1994;93(5):934–942
  84. Meyer AC, Lidsky ME, Sampson DE, Lander TA, Liu M, Sidman JD. Airway interventions in children with Pierre Robin sequence. Otolaryngol Head Neck Surg. 2008;138(6):782–787
  85. Heaf DP, Helms PJ, Dinwiddie R, Matthew DJ. Nasopharyngeal airways in Pierre Robin syndrome. J Pediatr. 1982;100(5):698–703
  86. Anderson KD, Cole A, Chuo CB, Slator R. Home management of upper airway obstruction in Pierre Robin sequence using a nasopharyngeal airway. Cleft Palate Craniofac J. 2007;44(3):269–273
  87. Olson TS, Kearns DB, Pransky SM, Seid AB. Early home management of patients with Pierre Robin sequence. Int J Pediatr Otorhinolaryngol. 1990;20(1):45–49
  88. Kiely JL, Deegan PC, McNicholas WT. Resolution of obstructive sleep apnoea with growth in the Robin sequence. Eur Respir J. 1998;12(2):499–501
  89. Schmidt-Nowara WW. Continuous positive airway pressure for long-term treatment of sleep apnea. Am J Dis Child. 1984;138(1):82–84
  90. Figueroa AA, Glupker TJ, Fitz MG, BeGole EA. Mandible, tongue, and airway in Pierre Robin sequence: a longitudinal cephalometric study. Cleft Palate Craniofac J. 1991;28(4):425–434
  91. Villa MP, Pagani J, Ambrosio R, Ronchetti R, Bernkopf E. Mid-face hypoplasia after long-term nasal ventilation. Am J Respir Crit Care Med. 2002;166(8):1142–1143
  92. Li KK, Riley RW, Guilleminault C. An unreported risk in the use of home nasal continuous positive airway pressure and home nasal ventilation in children: mid-face hypoplasia. Chest. 2000;117(3):916–918
  93. Marcus CL, Rosen G, Ward SL, Halbower AC, Sterni L, Lutz J, et al. Adherence to and effectiveness of positive airway pressure therapy in children with obstructive sleep apnea. Pediatrics. 2006;117(3):e442–e451
  94. Massa F, Gonsalez S, Laverty A, Wallis C, Lane R. The use of nasal continuous positive airway pressure to treat obstructive sleep apnoea. Arch Dis Child. 2002;87(5):438–443
  95. Stern Y, Segal K, Yaniv E. Endoscopic adenoidectomy in children with submucosal cleft palate. Int J Pediatr Otorhinolaryngol. 2006;70(11):1871–1874
  96. Finkelstein Y, Wexler DB, Nachmani A, Ophir D. Endoscopic partial adenoidectomy for children with submucous cleft palate. Cleft Palate Craniofac J. 2002;39(5):479–486
  97. Saunders NC, Hartley BE, Sell D, Sommerlad B. Velopharyngeal insufficiency following adenoidectomy. Clin Otolaryngol Allied Sci. 2004;29(6):686–688
  98. Gosain AK, Remmler D. Furlow palatoplasty to restore velopharyngeal competence following tonsillectomy avulsion of a pharyngeal flap. [Review] [57 refs] Cleft Palate Craniofac J. 2001;38(1):84–88
  99. Smith JD. Treatment of airway obstruction in Pierre Robin syndrome. A modified lip–tongue adhesion. Arch Otolaryngol. 1981;107(7):419–421
  100. Freed G, Pearlman MA, Brown AS, Barot LR. Polysomnographic indications for surgical intervention in Pierre Robin sequence: acute airway management and follow-up studies after repair and take-down of tongue–lip adhesion. Cleft Palate J. 1988;25(2):151–155
  101. Buchenau W, Urschitz MS, Sautermeister J, Bacher M, Herberts T, Arand J, et al. A randomized clinical trial of a new orthodontic appliance to improve upper airway obstruction in infants with Pierre Robin sequence. J Pediatr. 2007;151(2):145–149
  102. Moore CC, MacDonald I, Latham R, Brandt MG. Septopalatal protraction for correction of nasal septal deformity in cleft palate infants. Otolaryngol Head Neck Surg. 2005;133(6):949–953
  103. Saito K, Ono T, Mochida M, Ohyama K. Changes in nasorespiratory function in association with maxillary distraction osteogenesis in subjects with cleft lip and palate. Cleft Palate Craniofac J. 2006;43(1):75–83
  104. Wolford LM. Effects of orthognathic surgery on nasal form and function in the cleft patient. Cleft Palate Craniofac J. 1992;29(6):546–555
  105. Trindade IE, Yamashita RP, Suguimoto RM, Mazzottini R, Trindade AS. Effects of orthognathic surgery on speech and breathing of subjects with cleft lip and palate: acoustic and aerodynamic assessment. Cleft Palate Craniofac J. 2003;40(1):54–64
  106. Ermens F, Van GG, Kahn A, Blum D. Obstructive sleep apnea syndrome in childhood. Acta Otorhinolaryngol Belg. 1984;38(3):268–277
  107. Ruddy J, Stokes M, Pearman K. Pharyngoplasty surgery and obstructive sleep apnoea. J Laryngol Otol. 1991;105(3):195–197
  108. Eufinger H, Eggeling V. Should velopharyngoplasty and tonsillectomy in the cleft palate child be performed simultaneously?. Journal of Oral & Maxillofacial Surgery. 1994;52(9):927–930
  109. Denny AD, Kalantarian B, Hanson PR. Rotation advancement of the midface by distraction osteogenesis. Plast Reconstr Surg. 2002;111(6):1789–1799
  110. de Buys Roessingh AS, Herzog G, Hohlfeld J. Respiratory distress in Pierre Robin: successful use of pharyngeal tube. J Pediatr Surg. 2007;42(9):1495–1499
  111. Pasyayan HM, Lewis MB. Clinical experience with the Robin sequence. Cleft Palate J. 1984;21(4):270–276

PII: S1087-0792(09)00024-0

doi: 10.1016/j.smrv.2009.03.001

Sleep Medicine Reviews
Volume 13, Issue 5 , Pages 345-354 , October 2009

Article Tools