CLEFT LIP & PALATE
A cleft lip and/or a cleft palate can occur during the early stages of pregnancy, when either the tissue of the upper lip or the tissue of the roof of the mouth do not form and join correctly, resulting in a split or gap that is called a ‘cleft’. For a cleft lip, there may be a gap or opening in the upper lip either on one or both sides, which may spread to the nose. Clefts may also involve the upper jaw (alveolus). Clefts may be unilateral (one side) or bilateral (both sides).
Surgical treatments can be planned in 4 different age groups:
- Newborn-12 months
- 1-5 years
- 5-13 years
- 13-18 years
Newborn-12 months
All newborn babies are examined by a pediatrician in the hospital. If the child is born with a cleft lip and / or palate, the pediatrician usually asks the baby to be examined by a plastic surgeon or mouth, teeth and jaw surgeon. Cleft lip and palate feeding and respiration may be problematic. The timing of cleft lip and palate treatment may vary from surgeon to surgery. In general, the lip and then the palate should be treated surgically if available. It is thought that the optimal treatment timing of lip slits should be between 0-6 months. However, for the lip slit to be treated surgically, the weight of the child should be at least 4.5 kg, the blood hemoglobin value at least 10 g / dl and the child should be at least 10 weeks old. A short time after birth, a feeding plate is being made by orthodontists in order for the child to be able to feed properly during the time until the lip surgery is performed. Thus, negative pressure between the lips and the breast can be provided for the child's mothers to breastfeed, and there is no problem in feeding.
When the child is in a suitable situation, the lip repair is done surgically and an appropriate aesthetic appearance and function can be provided for both the parents and the child.
In general, palate clefts can be repaired between 18 and 24 months when speech begins. Today, due to modern anesthesia and asepsis, antisepsis, broad spectrum antibiotics, this age interval has narrowed down. However, you must not delay the operation date later than these months when the child's speech habit is acquired.
1-5 years
The most important feature of this time interval is the development of speech that requires good hearing. Children with cleft palate may have ear problems that can lead to hearing impairment. For this reason, it may be necessary to attach ear tubes to the child. If the scar left by the lip of the lips is not ideal, a scar revision can be made during this period. From time to time, a hole or fistula may develop after repair of the palate. As a result, food and liquids can escape int the nose. This hole can also be repaired in the same period. Ear tube and scar revision can be performed in the same surgery.
5-13 years
Children with a cleft palate may have problems with crowding and gums. Orthodontists, after the age of 5-6 use a variety of tools to fix the teeth. Bone grafting may be needed to support dog teeth during this period, to provide support to the nasal floor and other teeth. This procedure is usually performed with bone fragments from the hip bone. Despite the treatments, if the child's speech is problematic, it can be corrected with an operation called pharyngoplasty. This surgical procedure helps smooth out the sounds from the narrow back of the throat.
13-18 years
In this period, operations for skull revisions, rhinoplasty (nose correction) and jaw surgery to correct crowded teeth are carried out. Rhinoplasty and jaw surgery can be performed when facial development is complete. The ideal time for this is between 16 and 18 years old.
Children with cleft lip & palate may have hearing, speech, feeding difficulties and dental problems, hence it is likely a team of specialists including Paediatricians, Speech Pathologists, ENT (Ear, Nose & Throat) Surgeons, Audiologists, Plastic Surgeons, Oral & Maxillofacial Surgeons, Orthodontists and Dentists will work with the child and their family on an ongoing basis throughout their childhood and potentially into adulthood.
Figure 1. Babies born with a cleft lip should be operated as soon as possible in order to be fed, to provide aesthetics and to relax the family psychologically. These operations are performed successfully in our hospital.