Cleft Lip and Cleft Palate
Cleft lip and cleft palate, also known as orofacial cleft, are facial and oral deformations that occur in early stages of pregnancy, while the baby is developing inside the mother therefore cleft lip and cleft palate are birth defects.
Cleft lip and palate are the result of when there is not enough tissue in the mouth or lip area, and the tissue that is existing cannot get together correctly during development.
A cleft lip is a physical split or separation of the two sides of the upper lip and appears as a slight opening or gap in the skin of the upper lip. This separation often spreads beyond the base of the nose and includes the bones of the upper jaw and/or upper gum. The opening or the gap may be on one side, both sides, or in the middle.
These complaints may result in;
- feeding problems,
- speech problems,
- hearing problems,
- frequent ear infections,
- socialization problems.
Causes of Cleft Lip and Cleft Palate
- smoking during pregnancy
- an older mother
- certain medications
can be the cause of cleft lip and cleft palate. These diseases can be diagnosed with an ultrasound during pregnancy.
A cleft lip or palate can be successfully treated with surgery. This surgery is generally done in the first few months of life for cleft lip and before eighteen months for cleft palate.
Most patients who have their cleft surgery early enough can have a pleased youth and social life.
The aim of treatment for cleft lip and cleft palate are to increase the child’s ability to eat, speak and hear normally and to achieve a standard facial appearance.
Treatment includes surgery to fix the defect and therapies to improve any related complications.
Cleft Lip and Cleft Palate Surgery
- Cleft lip repair surgery: To fix the gap in the lip, the surgeon makes incisions on both sides of the cleft and creates flaps of tissue, then stitch the flaps together. The repair should create a standard lip appearance, structure and function. Initial nasal repair, if needed, is generally done at the same time.
- Cleft palate repair surgery:Several procedures may be used to close the gap and reconstruct the roof of the mouth (hard and soft palate), depending on patient’s situation. The surgeon makes incisions on both sides of the cleft and moves the tissue and muscles and repair them then stitch them together.
- Ear tube surgery: For children with cleft palate, ear tubes may be used, usually at 6 months of age, to decrease the risk of chronic ear fluid, which may cause to hearing loss. Ear tube surgery includes placing tiny bobbin-shaped tubes in the eardrum to create an opening to avoid fluid buildup.
- Surgery to reconstruct appearance:Additional surgeries may be needed to improve the appearance of the mouth, lip and nose.
For these surgeries patient will receive a general anesthetic.
The surgeon may suggest follow-up surgeries to improve speech or improve the appearance of the lip and nose. Speech therapy and dental care can also be needed. With appropriate and successful treatment, patients will have a normal life with normal facial appearance.
A submucous cleft palate is a congenital defect of the palate, which forms the roof of the mouth. The cleft (or opening) is underneath the mucous membrane, which is the tissue that covers the roof of the mouth.
A submucous cleft affects the uvula, which is the long tissue that hangs from the back of the palate. The cleft also goes under part or all of the mucous membrane covering the soft palate (also called velum). In severe cases, the submucous cleft can extend under both the soft and hard palate.
The lip and palate cleft can be detected after the third month of pregnancy using ultrasound and parents can begin to look for ways to treat the child’s lip and palate cleft and the problems they will face after the baby is born.
Babies with cleft lip and palate have difficulty feeding. Therefore, babies should be fed with their head up and the opening of their bottle should be expanded. Since babies with cleft lip and palate will get tired more quickly than other babies when feeding, feeding time should be kept long and we should be patient.
Babies with cleft palate are speech impaired. So it is important to treat their cleft lip and palate without delay after that make them undergo speech therapy in order to avoid permanent disorders in their speeches. In case of speech therapy is not applied or applied late the speech disorder of the child might become permanent.
Preferably, surgery should be performed in the first 3 months. The doctor decides the appropriate time of the operation during the first 12 months depending on baby’s weight and blood values.
If not treated, babies will have a lot of problems; these problems start with feeding problems and continue with middle ear inflammation and hearing difficulties. Also a speech disorder will be noticed when the baby starts to speak, this speech disorder is permanent because it is not treated.
Apart from all these problems the baby psychology will adversely affected due to his/her different look from normal individuals
- Cleft lip and palate is a congenital anomaly which is seen in one out of every 1000 babies.
- Cleft lip and cleft palate treatment should be completed when the baby is 1 year old. Serious speech disorders may occur when babies start talking if their cleft lip and cleft palate are not treated.
- The best time for cleft lip surgery is determined by considering the baby’s weight and blood values.
- If babies with cleft lip and palate have problems in the shape of the nose, lip, jaw and teeth or speaking problems they might need to undergo an additional surgery to correct these problems.
- Babies who undergo cleft lip and palate surgery may also need speech therapy in the future.
- Cleft lip and palate treatment is a long process so families need to be patient and be aware of all details of this process.
Babies who had cleft lip surgery stay in the hospital on the night of surgery and they are discharged the next day after all checks. After surgery babies should be fed with small spoons in a sitting position.
Contamination of the surgical incision with nasal Mucus or baby food should be avoided. Cleanliness of the incisions is very important so after surgery it is recommended to dress the incision with antibiotic pomades daily until the incision heals. Incision should be kept dry and clean. All sutures are removed 1 week after the operation.
After cleft lip surgery, families should take a good care of their baby and if they see any changes in their baby they should contact with their doctor.
As well as cleft palate is a problem that negatively affects nutrition it also affects speaking. In cases of cleft palate, there are problems such as difficulty in speech and difficulty in making some sounds because soft palate movements are not fully carried out. So the palate muscles are repaired during surgery to prevent such problems. In such cases, surgery alone may not be enough and Postoperative speech therapies are needed.
No matter how advanced technology is, removing scars completely is impossible. Acne, birthmarks or sunspots can be removed by laser, but surgical scars cannot be removed. Still there are some specific techniques that help to reduce the size of scars as much as possible, also following the appropriate treatment and massage for 6 months after the surgery helps with reducing of scars size, at the end of treatment the scar become in the form of thin line.
Since the cleft palate surgery is performed on an invisible part of the body, the presence of these scars is not as important as the cleft lip scars. Cleft palate scars take the form of a straight line.
The cleft lip and palate is formed as a result of a developmental disorder in the mother’s womb. The cleft lip and palate can affect some other areas. That’s why it is often require more than one surgery to treat this condition. However, if there is only a cleft lip without any other abnormalities in other areas cleft lip can be treated with just one surgery.
Children who have cleft palate suffer from suction problems, if it is not a very extreme situation there will not be swallowing problems.
The cause of the suction problem is due to the fact that the negative pressure cannot be created because the palate and nose are open. The child can be easily fed with a spoon or with a wide-opening bottle until undergoing the surgery. In severe cases, the child can be fed with the help of a nasal catheter.
Cleft lip and palate is a problem related to the growth of the baby and mostly carries genetic features. Abnormalities can also be seen in other parts of the body. However, they are mostly born with cleft lip and palate deformity and no other pathology is seen.
Babies with only cleft lip can start feeding a few hours after surgery. However, babies with cleft palate begin feeding a few hours after the surgery, but they are fed with liquid foods that do not contain particulates from 5 to 7 days, after that they can gradually fed with solid food.
Cleft lip and palate usually carries a genetic characteristic so If the mother and father had it the child also might have it, the normal incidence of cleft lip and palate is 1 out of 1000 births, but in case one of the parents or relatives have had cleft lip and palate the incidence of it decrease to 1 out of 100.
The treatment of cleft lip and palate is done by a team, this deformity is noticed by Midwife before the baby is born and can be detected at early time, Since these children will have ear problems, they are followed up by ear nose throat doctors. But the most important work lies on cosmetic doctors who are planning and implementing the surgery.
The help of speech therapists is needed since speech problems will be experienced after the surgery, and the support of the family is very important in this process, it is also possible to take support from psychologists from time to time.
All surgeries have certain risks and knowing these risks before the operation is very important.
The risks of cleft lip and palate are listed as the following:
- Respiratory problems
- Opening of the sutures
- Fistula formation
- Risks arise from anesthesia