During early pregnancy, separate areas of the face develop individually and then join together, including the left and right sides of the roof of the mouth and lips. However, if some parts do not join properly, sections don't meet and the result is a cleft. If the separation occurs in the upper lip, the child is said to have a cleft lip.
A completely formed lip is important not only for a normal facial appearance but also for sucking and to form certain sounds made during speech. A cleft lip is a condition that creates an opening in the upper lip between the mouth and nose. It looks as though there is a split in the lip. It can range from a slight notch in the colored portion of the lip to complete separation in one or both sides of the lip extending up and into the nose. A cleft on one side is called a unilateral cleft. If a cleft occurs on both sides, it is called a bilateral cleft.
A cleft in the gum may occur in association with a cleft lip. This may range from a small notch in the gum to a complete division of the gum into separate parts. A similar defect in the roof of the mouth is called a cleft palate.
Q. What are the types of Cleft Lip ?
Cleft Lip can be 1) Unilateral Cleft Lip - On one side of the nose or 2) Bilateral Cleft Lip - On both the sides of the nose. Cleft Lip can either be 1) Complete Cleft Lip - When the split extends right up and into the nose or 2) Incomplete Cleft Lip - When the split in the upper lip does not extend up to the nose.
Q. What are the problems associated with Cleft Lip ?
Feeding Problems : -
Cannot suck effectively
Milk gets into the nasal cavity and may result in choking or aspiration
Teething Problems
Missing teeth
Increased number of cavities
Malocclusion of teeth - When teeth are bunched together or on top of each other.
Speech Problems : -
Nasal voice
May develop nodules on the vocal cord due to vocal abuse
Delayed speech and language development
Difficulty with articulation and proper pronunciation of words
Ear Infections
Most children with Cleft Lip are prone to middle ear infection
Hearing Loss
May be associated with repeated ear infection
Psychological Problems : -
To pay the price for looking and sounding different.
Social Problems : -
Suffer isolation and alienation
Planning for surgery
At your initial consultation, your doctor will discuss the details of the procedure he or she will use, including where the surgery will be performed, the type of anesthesia to be used, possible risks and complications, recovery, costs, and the results you can expect. Your surgeon will also answer any questions you may have about feeding your baby, by breast or by bottle, both before and after the surgery.
In most cases, health insurance policies will cover most or all of the cost of cleft lip or cleft palate surgery. Check your policy to make sure your child is covered and to see if there are any limitations on what types of treatment are covered.
Cleft lip surgery
A cleft lip can range in severity from a slight notch in the red part of the upper lip to a complete separation of the lip extending into the nose. Clefts can occur on one or both sides of the upper lip. Surgery is generally done when the child is about 10 weeks old. To repair a cleft lip, the surgeon will make an incision on either side of the cleft from the mouth into the nostril.
He or she will then turn the dark pink outer portion of the cleft down and pull the muscle and the skin of the lip together to close the separation. Muscle function and the normal "cupid's bow" shape of the mouth are restored. The nostril deformity often associated with cleft lip may also be improved at the time of lip repair or in a later surgery.
[ Before ]
[ After ]
Figure : -A. Bilateral Cleft of the Lip, Alveolus and Palate. Note the forward position of the premaxilla and prolabium.
Figure : - B. The same person at age seventeen following lip, nose and palate repair, as well as extensive orthodontic treatment.
Recovering from cleft lip surgery
Your child may be restless for awhile after surgery, but your doctor can prescribe medication to relieve any discomfort. Elbow restraints may be necessary for a few weeks to prevent your baby from rubbing the stitched area. If dressings have been used, they'll be removed within a day or two, and the stitches will either dissolve or be removed within five days. Your doctor will advise you on how to feed your child during the first few weeks after surgery.
It's normal for the surgical scar to appear to get bigger and redder for a few weeks after surgery. This will gradually fade, although the scar will never totally disappear. In many children, however, it's barely noticeable because of the shadows formed by the nose and upper lip.
Cleft palate surgery
In some children, a cleft palate may involve only a tiny portion at the back of the roof of the mouth; for others, it can mean a complete separation that extends from front to back. Just as in cleft lip, cleft palate may appear on one or both sides of the upper mouth. However, repairing a cleft palate involves more extensive surgery and is usually done when the child is nine to 18 months old, so the baby is bigger and better able to tolerate surgery.
To repair a cleft palate, the surgeon will make an incision on both sides of the separation, moving tissue from each side of the cleft to the center or midline of the roof of the mouth. This rebuilds the palate, joining muscle together and providing enough length in the palate so the child can eat and learn to speak properly.
Recovering from cleft palate surgery
For a day or two, your child will probably feel some soreness and pain, which is easily controlled by medication. During this period, you child will not eat or drink as much as usual -- so an intravenous line will be used to maintain fluid levels. Elbow restraints may be used to prevent your baby from rubbing the repaired area. Your doctor will advise you on how to feed your child during the first few weeks after surgery. It's crucial that you follow your doctor's advice on feeding to allow the palate to heal properly.
After the Plastic Surgery
After the cleft lip and palate plastic surgery, the child experiences from IV and in order to decrease the inflammation, they are allowed to sleep in a crib. It is advised that the child should stay in a hospital for one or two days. A gel for the sutures can be applied or medicines like Tylenol in addition to codeine can be taken by the children suffering from extreme pain.
Benefits of surgical repair of Cleft Lip
The team approach to correcting Cleft Lip and other problems associated with it has several fold benefits. Symmetry or balance of facial features is restored to a great extent but not completely. The surgeons have mastered sophisticated techniques that have improved the success rate of surgery for Cleft Lip many fold. If the surgery to repair Cleft Lip is performed in the first year of life, chances are that ability to feed properly; talk, facial growth and development of social skills will be less problematic in the years to come.
Risks of surgical repair of Cleft Lip
Asymmetry of your child's upper lip - This is a common problem when one side of your mouth and nose do not match the other side. In such a case, a revision surgery is performed to try and match both the sides of the face as closely as possible.
Incomplete closure of the cleft - A small hole may be apparent in the upper lip after the operation for Cleft Lip has healed. A second operation may be required to completely repair the Cleft Lip.
Infection of the incision site
Allergic reaction to anesthesia
Bleeding, swelling, bruising and delayed healing - It is normal to have some bruising and oozing of bloody discharge around the mouth and nose which will subside in a week or so.
When surgery is done by a qualified plastic surgeon with experience in repairing cleft lip or palate, the results can be quite positive. Nevertheless, as with any operation, there are risks associated with surgery and specific complications associated with this procedure.
In cleft lip surgery, the most common problem is asymmetry, when one side of the mouth and nose does not match the other side. The goal of cleft lip surgery is to close the separation in the first operation. Occasionally, a second operation may be needed.
In cleft palate surgery, the goal is to close the opening in the roof of the mouth so the child can eat and learn to speak properly. Occasionally, poor healing in the palate or poor speech may require a second operation.
Appearance
After the surgery has been completed, the child can notice some redness in addition to swelling on the lips. One can keep small strips of tape on the cuts to maintain the repairing, to decrease the pressure on the suture line and to avoid the lips from rubbing and an unintended hit.
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A cleft in the gum may occur in association with a cleft lip. This may range from a small notch in the gum to a complete division of the gum into separate parts. A similar defect in the roof of the mouth is called a cleft palate.
