Table of Contents

HK J Paediatr (New Series)
Vol 22. No. 2, 2017

HK J Paediatr (New Series) 2017;22:119

Letter to the Editor

Cleft Lip and/or Palate and Congenital Heart Disease: Are There Additional Predisposing Factors for the Occurrence of Acquired Cardiovascular Diseases?

MR Tovani-Palone

Dear Editor,

Cleft lip and/or palate (CL/P) are common birth defects and they are associated with several factors that predispose to acquired cardiovascular diseases.1-3 Moreover, individuals with both CL/P and congenital heart disease are relatively common frequent.4 However, there is not much information found in the literature.

In patients with cleft palate the direct communication between oral and nasal cavities provides the constant passage for microorganisms from the external environment. In addition, the frequent use of antibiotics due the high frequency of recurrent otitis media may predispose into the growth of bacteria.1 Furthermore, children with CL/P have higher incidence of caries and periodontal disease when compared with children without CL/P, which contributes to an increase in the diversification and pathogenicity of the microbiological niches.2

Other important association is the respiratory difficulty in cases of Robin Sequence associated with cleft palate, it may require nasopharyngeal intubation or tracheostomy and/or nasogastric tube. Thus, on one hand it improves the breathing and nutritional management, on the other hand it provide additional access for entry of microorganisms.1

Therefore, all these conditions may provide favourable milieus for the cultivation of bacterial endocarditis in children with CL/P and congenital heart disease.

It is worth mentioning that there is a concern with

minimal weight gain to achieve the rehabilitative surgical procedures of CL/P often times based on the use of high calorie nutritional preparations. They are rich in sugars, through milk formulas. This can induce significant changes in microbiota,3 which may increase the risks for the occurrence of acquired cardiovascular disorders.5

Thereby, it becomes imminent for the need of more studies in the paediatric population with CL/P associated with congenital heart disease on the predisposing risk factors for the occurrence of acquired cardiovascular diseases.

So that, one can provide advice on rational use of antimicrobials.2 New findings can also help to modify therapeutic protocols in order to contribute to the improvement of the quality of life of the patients.

Declaration of Interest

The author declares no conflict of interest.

MR Tovani-Palone
Hospital for Rehabilitation of
Craniofacial Anomalies,
University of Sao Paulo, Bauru, Brazil

Correspondence to: Dr MR Tovani-Palone



1. Palone MRT, Silva TR, Vieira NA, Dalben GS. Sequência de Robin e suas repercussões sobre a microbiota bucal: revisão de literatura. Pediatr Mod [Internet] 2013 [cited 2016 mar 16];49:445-50. Available from:

2. Tovani-Palone MR, Saldias-Vargas VP, Ribeiro da Silva T. Viabilidade na prescrição de antibiocos para crianças com fissura labiopalatina durante o tratamento odontológico. Rev Fac Med 2015;63:331-3. DOI:

3. Tovani-Palone MR. Fissuras labiopalatinas, ganho de peso e cirurgias: leite materno versus fórmulas lácteas. Rev Fac Med 2015;63:695-8. DOI:

4. Shafi T, Khan MR, Atiq M. Congenital heart disease and associated malformations in children with cleft lip and palate in Pakistan. Brit J Plast Surg 2003;56:106-9. DOI: PMID:12791351.

5. Cabezas-Zabala CC, Hernández-Torres BC, Vargas-Zárate M. Azúcares adicionados a los alimentos: efectos en la salud y regulación mundial. Revisión de la literatura. Rev Fac Med 2016; 64:319-29. DOI:


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