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CONGENITAL ANOMALY
CLEFT LIP AND PALATE.
How does a cleft lip and palate develop?
The lip and palate appear in the womb in the first weeks of development. Under normal conditions, both sides of the lip and palate develop together. However, these areas of the body cannot be combined 1 in every 800 born children. The lack of fusion in the upper lip is referred to as the “cleft lip”, and the lack of fusion in the palate is referred to as the “cleft palate”.
In what forms can the lip cleft be seen?
Problems of non-union of the palate and lip arches can occur in different ways. These could be:
• Complete (full) lip cleft – one-sided
• Complete (full) lip cleft – double sided
• Incomplete (not complete) lip cleft – one-sided
• Incomplete (not complete) lip cleft – double-sided
These shapes can be viewed on one or both sides.
When are lip and palate cleft surgeries performed?
The operations on cleft lip and palate are not subject to a strict time limit with regard to the time of the operation. The timing of the operation is determined taking into account many parameters such as the general health status of the child, the degree of splitting, therapies that may be helpful in performing the preoperative treatment, the blood count of the infant and the weight status. Given all of these situations, for lip surgery it is best to do the surgery as early as possible in the first 3 months. The palate surgery should be performed between 10 and 18 months before the start of speaking in a period suitable for the child.
In what forms can the cleft palate be seen?
- Incomplete (not complete) cleft palate
- Complete (full) cleft palate
In which situations are the cleft lip and palate seen together?
Lip and palate clefts can be seen separately, but occur more frequently: Complete or incomplete lip clefts can occur on one or both sides.
How should the operation be planned?
When you visit your plastic surgeon for the first time, your doctor will give you detailed information about the surgical technique he is using, depending on the condition of the current problem. The family is informed about the surgical area, the type of anesthesia to be used, possible risks and complications. Your plastic surgeon will also answer any questions you may have, such as: whether you should feed your baby with your breast or a baby bottle before and after the operation.
How is a lip cleft correction done?
The anomaly of the cleft lip can range from a small notch in the red area of the upper lip to the entire upper lip, which separates from the nose towards the inside. The column can be on one or both sides of the lip. During the co-correction of the cleft lip, the surgeon makes an incision in the nostril on both sides of the cleft. Your surgeon turns the dark pink area inward and then closes the muscle and skin layers to correct the gaps. This achieves the arch-like shape and muscle function of the lip. A disturbance in the nostrils can be corrected in the first or later surgery, but several surgeries may be required to achieve symmetry.
How is recovery after lip cleft correction?
Your child may be restless in the early postoperative period, but your surgeon will recommend appropriate medication. Your child may need to wear gloves and elbow braces to prevent your child from fiddling with the stitches. If the wound has been closed with a dressing, this will open in a day or two. The stitches are removed on the seventh day. Your surgeon will tell you how to feed your child in the first few weeks. It is normal for the scar to become red and swollen in the first few weeks after the operation. This will decrease over time, but will not go away completely. Even so, it won’t draw attention to many children between the shadow of the nose and the lip.
How is a cleft palate correction carried out?
Anomaly of cleft palate; Some children may only have thinning at the back of the palate, while others may have a cleft across the entire palate. Like the cleft lip, the cleft palate can be single-sided or double-sided. Palate cleft correction requires more complex surgery and is usually done when the child is between 10 and 18 months old, i.e. if the surgery can be easily tolerated. Performing the operation before the baby begins to speak will help improve pronunciation.
During the operation, the surgeon makes an incision along both sides of the cleft and brings tissue to the midline cleft on both sides of the mouth. This closes the palate, corrects the muscle on the soft palate and creates a palate that is long enough to speak and swallow properly.
How is recovery after a palate correction?
Your child may have pain that can be easily relieved with medication in the first two days after surgery. During this time, your child will not want to eat or drink anything by mouth, so additional fluid therapy is given through the vascular access. Your child may need to wear gloves and elbow braces to avoid fiddling with the stitches. Your surgeon will tell you how to feed your child in the first few weeks. The most important thing is that you do exactly what the surgeon recommends to you to avoid problems with the palate healing.
Do children with cleft lip and palate have ear problems?
Children with cleft palate are predisposed to ear infections because the cleft affects the middle ear. To ensure the necessary drainage and ventilation, the ENT doctor can recommend attaching special plastic tubes to the eardrum.
What are the later treatments for children with cleft lip and palate?
Children with cleft lip and palate; After the lip and palate correction is finished and the gaps are closed, they must be operated on until the age of 18 to 20 years so that the lips, palate structures and dental arches approach as normally as possible. These children are; if there are problems with the nostrils; It is an operation that controls the nasal cartilage at the age of 3 to 5 years, the bone transplant at the age of 8 to 10 years with problems in the dental arch and the final aesthetic nose surgery at the age of 18.