Page 413 - Cote clinical veterinary advisor dogs and cats 4th

180 Cleft Palate and Acquired Palate Defects

• Advise owner to bring label or container SUGGESTED READING AUTHOR: Cristine Hayes, DVM, DABT, DABVT
(tightly sealed, and out of reach of pet Gwaltney-Brant SM: Miscellaneous indoor toxicants. EDITOR: Tina Wismer, DVM, MS, DABVT, DABT
or children) to assist in identifying active
VetBooks.ir ingredients/toxins. In Peterson ME, et al, editors: Small animal toxicol-
ogy, ed 3, St. Louis, 2013, Saunders, pp 291-298.

Cleft Palate and Acquired Palate Defects Client Education
Sheet

BASIC INFORMATION ○ Most rostral hard palate defects: mild nasal Acquired palate defects:
congestion, sneezing, and discharge • Causes include chronic infections (e.g.,
Definition • Secondary palate defects: failure to create severe periodontal disease, osteomyelitis/
• Cleft palate: congenital (present at birth) negative pressure for nursing, nasal discharge osteonecrosis), trauma (e.g., high-rise
defect of the hard and/or soft palate (drainage of milk from the nares during or syndrome, motor-vehicle trauma, electric
• Acquired palate defect: acquired (after birth) after nursing), coughing, gagging, sneezing, cord injury, projectile trauma, animal bites,
defect of the hard and/or soft palate nasal reflux, rhinitis, tonsillitis, laryngotra- foreign body penetration, pressure wounds
cheitis, aspiration pneumonia, poor weight secondary to malocclusion), neoplasms, and
Synonyms gain, and general unthriftiness surgical and radiation therapy.
Harelip, cleft lip: defect of the primary palate • Acquired palate defects
present at birth ○ Signs depend on the size and location of DIAGNOSIS
the defect; the larger the defect, the more
Epidemiology likely is it that clinical signs are present. Diagnostic Overview
SPECIES, AGE, SEX Small rostral defects may not cause clinical Clinical signs are suggestive of the disorder
• Dogs and cats of either sex signs beyond nasal discharge from local (classically, milk discharge from nostrils in
• Incidence for congenital defects higher in rhinitis. a nursing puppy or kitten; water and food
brachycephalic dogs and Siamese cats ○ Owners often report a causative event. discharge from nostrils in an adult animal), or
• Nursing difficulties noted in puppies and the defect is identified as an incidental finding
kittens soon after birth PHYSICAL EXAM FINDINGS during routine examination. In either situation,
• Cats after high-rise or motor-vehicle trauma Congenital clefts: complete assessment is done under sedation
• Small stature or anesthesia.
GENETICS, BREED PREDISPOSITION • Nasal discharge, sneezing
Inherited as autosomal recessive or irregularly • Auscultation: dyspnea, increased lung sounds, Differential Diagnosis
dominant genes wheezing, or crackles (aspiration pneumonia) Defects due to severe periodontitis (oronasal
• Oral examination (pp. 1125 and 1140) fistula [p. 720])
RISK FACTORS ○ Primary palate defects: harelip only
See Etiology and Pathophysiology below. (unilateral, midline, or bilateral lip defect); Initial Database
rostral hard palate defect only (unilateral • CBC, serum biochemistry panel, urinalysis:
ASSOCIATED DISORDERS or bilateral); or defects of the lip and most assessment of unthrifty patients
• Aspiration pneumonia rostral hard palate; can also be associated • Thoracic radiographs: evaluation of possible
• Sneezing, nasal discharge, chronic rhinitis with abnormalities of the secondary palate aspiration pneumonia
○ Secondary palate defects: midline hard
Clinical Presentation palate cleft can usually be visualized, Advanced or Confirmatory Testing
DISEASE FORMS/SUBTYPES but soft palate defect may be difficult to Oral examination under general anesthesia:
The upper lip and most rostral hard palate sup- evaluate without chemical restraint. define extent of secondary palate defects (p.
ported by the palatine processes of the incisive 1140)
bones constitute the primary palate. The hard Etiology and Pathophysiology
palate that is supported by the palatine processes Congenital clefts: TREATMENT
of the maxillae and the horizontal laminae of Etiology:
the palatine bones and the soft palate constitute • Hormonal: gestational glucocorticoid Treatment Overview
the secondary palate. administration Essential elements:
• Primary palate defects: unilateral, midline, • Infectious: viral induced • Treat and resolve aspiration pneumonia
or bilateral; unilateral defects are more often • Mechanical: intrauterine trauma before surgery.
found on left side. • Metabolic • Nutritional support (transoral tube feeding)
• Secondary palate defects • Nutritional until the patient with congenital cleft palate
○ Midline cleft of hard and soft palate or • Toxic: secondary to drug, viral toxins is of adequate age and health for surgery
soft palate only • Hereditary: autosomal recessive or irregularly • Consider postponing definitive repair for
○ Unilateral cleft of soft palate dominant genes; growth of palatine bones several weeks in the case of extensive tissue
○ Hypoplasia of soft palate in the fetus may compete with growth damage resulting from thermal/electric burns,
• Acquired palate defects can be located of the skull, especially in broad-skulled gunshot trauma, or infection/inflammation
anywhere on the hard or soft palate. (brachycephalic) dogs, to achieve normal or when teeth needed to be extracted at the
closure of the palatine plates. planned site of surgery.
HISTORY, CHIEF COMPLAINT Pathophysiology: • Complete closure of palate defects
• Primary palate defects • Defects of the primary and secondary palate
○ Lip defects only: owner may note physical result from a failure of fusion of paired (and Acute General Treatment
appearance. one unpaired) structures during development. Treat aspiration pneumonia, if present (p. 793).

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