"Cleft lip and palate is the commonest congenital craniofacial anomaly and a classic viva case — a paediatric, potentially difficult, shared airway with frequent associated anomalies. This topic is split into short, focused tabs; read them in order or jump to what you need."
How to use this topic — CritCare.in.Why Cleft Repair Is a Classic Viva Case
"Cleft lip and palate is the commonest congenital craniofacial anomaly. The anaesthetic challenge is the convergence of four problems in one small patient: a paediatric airway and physiology, a potential difficult airway, an airway shared with the surgeon, and frequent associated congenital anomalies — all against a background of recurrent respiratory infection and malnutrition."
Synthesised from Miller's Anesthesia & Stoelting's Anesthesia and Co-Existing Disease.- Paediatric patient — infant physiology, ↓ FRC, high O₂ consumption, temperature & fluid/blood-volume sensitivity.
- Difficult airway — difficult mask ventilation & difficult laryngoscopy/intubation (worse with retro/micrognathia & bilateral clefts).
- Shared airway — the surgeon and anaesthetist work in the same field → risk of tube kinking, obstruction, disconnection & accidental extubation.
- Associated congenital anomalies — especially syndromes and congenital heart disease.
- Bleeding — a vascular field in a small patient with a small blood volume.
Embryology & Classification
Embryology of the lip & palate, the incisive foramen, and the Veau classification with LAHSHAL notation.
🧩02 · SYNDROMES & CHDAssociated Syndromes, CHD & Implications
Pierre Robin, Treacher Collins, Goldenhar & more — and how airway difficulty changes with age; associated CHD; feeding, URTI & serous otitis media.
🗓️03 · TIMINGTiming of Surgery
The Rule of 10, timing of lip / soft-palate / hard-palate repair, and why not to operate in the neonate.
📋04 · PRE-OPPre-op Assessment & Concerns
History, airway exam & the COPUR score, investigations, optimisation — and the five anaesthesia concerns.
🗺️05 · INTRA-OPIntra-operative Management
Induction by airway, the shared-airway tricks, the RAE south-pole tube, Dingman gag & throat pack, Rose position and adrenaline limits.
🛏️06 · RECOVERYExtubation, Recovery & Analgesia
Awake extubation, causes of post-op airway obstruction, and multimodal nerve-block analgesia (infraorbital, palatine, maxillary).
🎓07 · PEARLSMistakes, Pearls & References
Common mistakes, viva-ready exam pearls and the reference list.