Cleft Lip & Palate
Cleft lip (split of the upper lip) and Cleft palate (split of the roof of the mouth) are common congenital deformity. It occurs when the separate areas of the face that develop individually and then join together, do not join properly. Cleft lip is a separation of the two sides of the lip and often includes the bones of the maxilla and/or the upper gum. Cleft palate is an opening in the roof of the mouth. It occurs when the two sides of the palate do not fuse as the unborn baby develops.
A unilateral cleft lip occurs on one side of the upper lip. A bilateral cleft lip occurs on both sides of the upper lip. In its most severe form, the cleft may extend through the base of the nose.
According to the studies every Year 35,000 cleft children are born in India (that is 1:800 births). Cleft Lip and palate is a disorder affecting millions of children around the world. It affects a child’s appearance, speech, teeth, eating, hearing and their ability to develop socially. Each of these issues may be noted at different ages, i.e., difficulty feeding and middle ear dysfunction are infant and early childhood issues. Children with cleft lip and palate cannot be breast-fed. This is because the oral and nasal areas are joined together due to the cleft palate. While eating, food comes out through the nose again as soon as the child swallows. Speech difficulties present themselves when the child reaches approximately two years of age. Repair of these problems is not only important medically, but also cosmetically and emotionally, since the child’s speech and physical appearance is impaired, which may lead to social isolation.
Cleft deformities often occur without any previous family history. Whether the defect is inherited is still under investigation. The cause can also be malnutrition, genetic and environmental factors. Among the factors that are known to increase the risk of a child’s developing CLP are smoking or drinking by the mother during pregnancy. On the other hand, the mother’s intake of folic acid and vitamin B6 are believed to reduce the risk of CLP. It is possible to diagnose CLP by ultrasound examination late in the first trimester or early in the second trimester of pregnancy.
Ideally, children with cleft lip and palate should be treated by a multidisciplinary specialist “cleft team” that may include surgeons, speech and language therapists, audiologists (hearing experts), dentists, orthodontists, psychologists, geneticists and specialist cleft nurses. Care and support of your child and the family should last from birth until your child stops growing at about age 18. The timing of surgery varies, but usually an operation to close the gap in the lip will be done about three months after the baby is born. Surgery to close the gap in the palate is usually done at about six months. As your child grows older, further surgery may be needed to improve the appearance of the lip and nose and the function of the palate. If there is a gap in the gum, a bone graft will normally be done when your child is between 9 and 12 years old. This will help their second teeth to anchor properly into the gum. Bone is usually taken from the hip or shin and grafted into the gap in the gum.
For most infants with cleft lip alone, the abnormality can be repaired within the first several months of life (usually when the baby is 3month old). This will be decided by your child’s surgeon. The goal of this surgery is to fix the separation of the lip. Sometimes, a second operation is needed.
Cleft palate repairs are usually done between the ages of 6 to 18 months. This is a more complicated surgery and is done when the baby is bigger and better able to tolerate the surgery. The exact timing of the surgery will be decided by your child’s physician. The goal of this surgery is to fix the roof of the mouth so that your child can eat and learn to talk normally. Sometimes, a second operation is needed.
If you have had a child with a cleft lip or palate, you may be offered genetic counselling to find out the chances of your next child being affected. However, in most cases the most sensible approach is simply to aim to have a healthy pregnancy. Smoking and drinking alcohol have been shown to increase the risk of babies being affected, and can cause other birth defects.
There are different types of facial deformities:
Cleft Lip / Cleft Palate
Microtia means a small, abnormally shaped or absent external ear. It can occur on one side of the head (unilateral) or on both sides bilateral). The unilateral form is much more common, occurring in approximately 90 percent of patients, mostly males, and on the right side more often than on the left. Microtia occurs once in every 4,500 births in the general population; bilateral microtia occurs once in every 18,000 birth.
The causes of microtia are difficult to define. Some theories point toward a decrease in blood supply to the developing ear in utero. Others involve certain medications taken by the mother during pregnancy, such as Accutane, Thalidomide, and retinoic acid. Environmental factors have also been considered.
Cleft Lip & Palate
1. 0 – 6 Month – Child Care
Adjuvant Procedure Strapping
2. Primary Cleft Lip- Unilateral – Bilateral
3. Primary Cleft Palate – Unilateral – Bilateral
Submucous Cleft Palate
4. Speech Assessment
6. Vomerine Bone – Repositioning
7. Orthognathic – Maxilla Mandible