Cleft Palate in a Puppy – Key Vocabulary

Case Introduction and Learning Objectives

• Presenter: Dr. Iska Larkin, Lecturer, Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida.
• Purpose of the session:
  • Introduce students to a real‐world clinical case involving a puppy.
  • Correlate embryological development with resulting health impacts.
  • Demonstrate how information is received by a veterinarian, processed, and translated into diagnostic and therapeutic decisions.
  • Review background information so students can identify characteristics, treatments, and risks associated with the condition.

Initial Presentation and Clinical Findings

• Client context:
  • Client rescued a stray bitch with a litter; one puppy is failing to thrive.
• Primary complaints:
  • Saliva constantly dripping from the mouth.
  • Regurgitation through the nose when bottle-fed; milk exits nasal passages.
  • Marked sneezing and snuffling, especially during or after feeding.
  • Puppy smaller and under-weight compared with littermates (stunted growth).
• Preliminary diagnostics:
  • Complete blood count/serum chemistry suggest pneumonia.
  • Transtracheal (lung) wash grew Amanas (a bacterium) on culture.
• Initial working diagnosis: respiratory-tract infection (pneumonia secondary to bacterial aspiration).
• First-round therapy:
  • Broad-spectrum antibiotics.
  • Corticosteroids to reduce airway inflammation.
  • Puppy discharged with instructions for continued monitoring.

Re-examination and Definitive Diagnosis

• Puppy returns; condition deteriorating and now lethargic.
• Because the patient is calmer and less hyperactive, the veterinarian performs a more thorough oral exam.
• Discovery: a secondary cleft palate involving the soft palate.
  • Explains chronic nasal regurgitation, feeding difficulty, and repeated aspiration leading to pneumonia.

Cleft Palate: Definition & Embryological Context

• A cleft palate is a failure of the tissues surrounding the nasal and oral cavities to fuse during embryogenesis.
• Two major anatomic regions involved:
  • Primary palate — structures anterior to the incisive foramen (lip/upper jaw).
  • Secondary palate — posterior structures (hard palate, soft palate, and uvula).
• Embryological significance:
  • Palatal shelves must elevate, approximate, and fuse on the midline.
  • Disruption (genetic, teratogenic, mechanical) before completion of fusion results in a cleft.

Classification of Cleft Palates

• By anatomic extent (examples given visually during lecture):
  1. Unilateral cleft lip & palate — defect on one side; involves nose, lip, and palate.
  2. Bilateral cleft lip & palate — both sides; can affect nose, lip, hard palate, and soft palate.
  3. Isolated soft-palate cleft — only secondary palate affected.
  4. Cleft lip & alveolus — defect limited to lip and gingival/alveolar tissue.
• By origin:
  • Congenital (present at birth; often genetic or teratogenic).
  • Acquired (post-natal trauma, disease, or iatrogenic causes).

Etiology

Congenital Factors

• Breed predisposition (polygenic inheritance or breed-linked mutations):
  • Miniature Schnauzer, Beagle, Cocker Spaniel, Dachshund.
  • Siamese cat lines.
  • Brachycephalic breeds (short skull, wide muzzle) have increased tissue distance that must fuse: Boston Terrier, Pekingese, Bulldog, Boxer.
• Maternal/environmental insults during gestation:
  • Excessive Vitamin A supplementation.
  • Cortisone administration to the dam.
  • Certain viral infections.
  • Hypoxia (low fetal oxygen).
  • Pesticide/teratogen exposure.

Acquired Factors

• Falls/trauma causing mid-face fractures.
• Electrical-cord chewing → burning/perforating soft palate.
• Penetrating injuries from splintered bones or foreign objects.

Clinical Signs & Pathophysiology

• Oral-nasal communication → milk/food enters nasal passages.
• Aspiration of food/liquid → bacterial pneumonia, coughing, sneezing.
• Failure to thrive: difficulty suckling, caloric deficit, weight loss.
• Secondary signs: gagging, chronic rhinitis, recurrent respiratory infections, and audible snuffling during eating.

Diagnostic Workflow & Decision Points

• Step 1: Initial physical exam; note underweight status, oral discharge.
• Step 2: Basic labs; CBC/chemistry and imaging (if accessible).
• Step 3: Rule out pneumonia via lung wash/culture; identify opportunistic bacteria.
• Step 4: Detailed oral examination (may require sedation) to visualize soft palate.
• Adjunct tests: Skull radiographs or CT for palatal bone involvement; endoscopic nasal evaluation if needed.

Treatment Options

• Surgical repair is definitive management.
  • Goal: achieve watertight separation between oral and nasal cavities.
• Pre-surgical management:
  • Broad-spectrum antibiotics for aspiration pneumonia.
  • Nutritional support (feeding tubes, specialized nipples).
  • Delay surgery until puppy is strong enough (usually 8–12 weeks of age) yet before chronic infection causes irreversible damage.

Surgical Technique (Overview from linked resource)

• Tissue flaps are elevated alongside the cleft.
• Mucoperiosteal or double-layer closure is performed to minimize tension.
• Soft-palate portion requires careful alignment to preserve swallowing and phonation functions.
• Post-closure, oral defect appears as a continuous midline seam.

Post-Operative Care & Risks

• Anesthetic considerations: Young, underweight animals at higher risk for hypothermia and hypoglycemia.
• Respiratory complications:
  • Existing pneumonia may flare under anesthesia.
  • Airway obstruction from post-op swelling.
• Infection risk: surgical site continually bathed in saliva and food; strict oral hygiene necessary.
• Pain & swelling: analgesics and anti-inflammatories prescribed.
• Appetite suppression: may need temporary feeding tube until healing adequate.
• Potential for dehiscence (suture line breakdown) requiring revision surgery.

Ethical & Practical Considerations

• Decision-making must weigh surgical cost, prognosis, potential chronic morbidity, and owner resources.
• Early detection is critical; improved neonatal exams prevent prolonged suffering.
• Responsible breeding: avoid mating animals with heritable cleft palate traits.
• Educate owners on teratogens during pregnancy (e.g., over-supplementation with Vitamin A or unnecessary steroids).

Further Reading / Resources

• Three recommended links provided by Dr. Larkin cover:
  1. Detailed cleft-palate surgical techniques.
  2. Genetic and breed-specific studies on orofacial clefts.
  3. Post-operative nursing protocols and feeding strategies.

Key Takeaways

• Chronic nasal regurgitation, sneezing, and poor growth in neonates should trigger oral examination for a cleft palate.
• Secondary cleft palate may be subtle externally yet highly morbid internally.
• Aspiration pneumonia is a common sequela; address medically while planning surgery.
• Multifactorial etiology: genetics, teratogens, and trauma can all contribute.
• Surgical correction, though delicate, usually yields a good prognosis when performed early and coupled with diligent post-operative care.