CLEFT LIP & PALATE SURGERY
Cleft lip and cleft palate are birth defects that occur when a baby’s lip or mouth do not close properly during pregnancy.
Cleft lip & cleft palate are openings or splits in the upper lip, inside mouth (palate) or both.
How common is Cleft Lip and Palate?
Cleft lip and cleft palate are one of the most common birth defects.
It affects 1 in 700 babies born annually worldwide. They most commonly occur as isolated birth defects but are also associated with many inherited genetic conditions or Craniofacial syndromes.
Usually, a split or opening (cleft) in the lip or palate that affects one or both sides of the face is immediately seen at the birth.
An opening in the roof of the mouth that doesn’t affect the appearance of the face.
Child with cleft lip with or without cleft palate face a variety of challenges, depending on the type and severity of the cleft.
- Difficulty with feedings.
Feeding is one of the most immediate concerns after birth. Most babies with cleft lip can breast-feed, a cleft palate may make sucking difficult due to air leak.
- Difficulty in swallowing, with chances for liquids or foods to come out the nose
- Nasal tone in voice during speaking
- Chronic ear infections and hearing loss.
- Infants with cleft palate are especially at the risk of developing middle ear fluid and hearing loss.
- Dental problems. If the cleft extends through the upper gum and bone, tooth development may be affected.
- Growth restriction in midface.
25% will require Orthognathic or Jaw Surgery.
- Speech difficulties. The normal speech can be affected by a cleft palate. Speech may sound too nasal. Velopharyngeal insufficiency (VPI) occurs in 20 %.
Challenges of coping with a medical condition. Children with clefts may face social, emotional and behavioral problems due to differences in appearance and the stress of intensive medical care.
A baby born with a cleft lip or palate can be distressing, but cleft lip and cleft palate can be corrected.
Generally, a series of surgeries can restore normal function and achieve a more normal appearance and function of lip and mouth with minimal scarring.
The Cleft lip & palate repair is a surgical procedure performed to re-establish the appearance and function of the upper lip and roof of the mouth when a cleft, or separation of the upper lip and roof of the mouth, is formed during pregnancy.
Additional surgeries may be required to improve the appearance of the lip and nose along with surrounding structures, close openings between the mouth and nose, help breathing, and stabilize and realign the jaw.
Facial scar revision of the scars left by the initial surgery will probably not be performed until adolescence, when the facial structure is more fully developed over the years.
Timing of Surgical Correction
- Cleft lip repair
Rule of 10s
>= 10 weeks of age
>= 10 g/dL hemoglobin
>= 10 lbs
- Cleft palate repair
9 to 12 months of age
12 to 18 months of age for children with developmental delay, Pierre Robin syndrome, medical comorbidities
- Pharyngeal flap (VPI management)
3 to 5 years of age but may be performed later (timing dependent on speech development)
- Autogenous cancellous bone graft
4 to 6 years of age (early secondary grafting) Performed prior to eruption of permanent incisors
Autogenous cancellous Iliac crest bone graft
Gold standard
8 to 12 years of age (late secondary grafting Performed once 1/2 to 2/3 of the canine root is developed.
- Cleft orthognathic surgery
Girls from 14 to 16 years of age; boys from 16 to 18 years of age.
Most patients with a history of Cleft Lip and Palate have a Class ll tendency, and if possible orthognathic surgery should be delayed until skeletal maturity is reached
- Cleft rhinoplasty
Most commonly performed once skeletal maturity is reached If orthognathic surgery is needed, rhinoplasty or nose surgery should be performed following orthognathic surgery, if possible
- Lip revision
Can be done at any time.
If indicated in teenage patient requiring orthognathic surgery, may be beneficial to perform following orthognathic surgery
A cleft lip and cleft palate are usually noticed at birth, and its right time for doctor to start coordinating care at that time.
If you are looking for Cleft lip & palate repair, you may consider Facial Plastic Surgery.
Learn more:
The Cleft lip & palate repair in Delhi NCR by Dr. Punit Dubey