Cleft lip and palate defect is one of the most common congenital defects. These are a heterogeneous group of disorders which are divided into two groups-
- Isolated Cleft Palate where there is opening or split in the roof of the mouth. In this the appearance of the face is unaffected.
- Cleft lip where the upper lip has a split. This condition may or may not be accompanied by cleft palate.
These disorders occur 1 in 1000 newborn babies having geographic variations. Among this 29%, children have associated congenital deformities. This condition develops when the facial structures of an unborn baby do not close properly at the time of fetal development.
Treatment of patients involves care from the multi-disciplinary team early on to evaluate patients totally for other co-morbidities and other associated congenital disorders. Surgical intervention for initial cleft lip starts at 3 to 5 months of age whereas it takes 9 to 12 months of age for associated cleft palate. Surgical management of cleft involves many stages; first the lip is closed with sutures at as early as 10 weeks old and at 12 months palate will be closed. Further surgery includes pharyngeal flap surgery and sphincter pharyngoplasty.
The cleft lip and palate affects main functions like:
- Facial growth
- Dental occlusion
- Psychological aspects
Advantages of Cleft Lip and Palate Surgery
The surgery modifies the physical shape of the cleft lip. This will further benefit to avoid social stigma and in boosting self-confidence and influence other social changes. The surgery will further enhance the speaking skills, the process of eating, and hearing as well.
The child will not be able to drink or eat anything for several hours before the surgery. Parents must make sure the child is healthy before the surgery. If the child is ill, surgery may be delayed. Medications are given for the child's comfort during the surgical procedures which may include intravenous sedation and general anesthesia and the doctors will recommend the best choice for the child. The surgeon may mark an incision on either side of the cleft from the lip to the nostril and then align the muscles before closing the lips to have normal lip function.
- The medical team may suggest for complete blood picture and check the child's blood type
- Take a complete medical history of the child
- Do a complete physical exam of the child
- Details of any medications being given to the patient must be provided to the doctor including any without prescription like drugs, herbs or vitamins
- The child should not be medicated with drugs like aspirin, ibuprofen, warfarin, and any other drugs that make it hard for your child's blood to clot before the surgery
- The medical team will make sure the child is healthy to avoid delay in surgery
- Topical Anesthetics is important to use in the region to be infiltrated to avoid scars and to prevent excessive pain
- The slow anesthetic administration is done to avoid the painful sensation
- The surgeon will trim the tissues and sew the lip together
- The surgeon recreates the lip and the nose with the help of small cuts. Made on both sides of the cleft, these cuts help to create skin flaps using intraoral muscle and tissue. These are then stitched with care to close the cleft.
- Closure of cleft lip, alveolus and palate
- Correction of the nasal form
- Repositioning of tissue and muscles of the soft palate muscles
- Once the cleft lip and/or cleft palate are repaired, the incisions will be closed with absorbable sutures
- As the patient grows, secondary procedures may be needed to have proper speech and palatal or lip procedures depending on their function and scarring
- Orthodontic treatment is performed when the child begins to lose baby teeth to have a proper alignment of the teeth avoiding abnormal positions
- Over time, sutures will fade and the child’s ability to grow and function normally will improve
The first two weeks after surgery, enough care should be taken to prevent any damage.
- The child will be asked to stay in the hospital for 5 to 7 days right after surgery
- Complete recovery may take up to 4 weeks
- The wound must be kept clean during the healing process
- Furthermore, the wound must not be stretched or pressed for at least 3 to 4 weeks
- The concerned nurse will give instructions regarding how to take care of the wound
- The wound will require cleaning with soap and water or a special cleaning liquid and application of recommended ointment
- Until the wound heals, the child will be on a liquid diet
- It is important for your child not to put hands or toys in the mouth
- For feeding the child, a special cleft lip feeder which has a syringe fitted with special soft tubing can be used
- Do not touch or handle the surgical area of child's lip
- Allow any dried blood or crusty material to fall off on its own
- A child must wear arm restraints for the first 10 days after surgery
- A child will have mild to moderate pain for a few days
- Acetaminophen should be given for pain relief
Risks involved in Cleft lip and Palate Surgery
The risks associated with cleft lip and palate surgery can be managed efficiently by specialists. However, certain factors may sometimes cause failure of fusion. These include:
- Infection at the site of surgery
- Slight breathing problems
- Allergies due to suture materials
- Residual irregularities and asymmetries in the lip or nose
Another possible complication is oronasal fistula in which the surgery area does not heal for a variety of causes. This could result in regurgitation of food and liquid as well as difficulty in speech.
Factors affecting Cost of Cleft lip and Palate Surgery
- The surgeon and medical team fee and his team
- Anesthesia fee
- Medical prescriptions
- Medical tests
- Post surgery feeding supplies