Cleft Lip & Palate Surgery

Celebrating a birth
The birth of a healthy child is a moment of celebration for parents and all others related alike. But it turns out be a sad experience to find newborn child with a birth defect of Cleft Lip and Palate. The immediate relations, particularly parents, and friends fall in psychological stress and start worrying about future development of the child. The birth defects could either involve the external parts or internal organs separately or may be both in varying combinations. As far as the birth involving internal organs is concerned, they do not have significant immediate bearing to cause psychological stress. Today, much advancement has already been made in the surgical techniques. The deformity of Cleft Lip & Palate is no longer an unfortunate situation and is easily treatable. The same could be reconstituted to a near normal appearance and function.

Overview
Cleft lip is a most common genetic birth defect syndrome involving a split in the upper lip. The centre of the roof of the mouth is called palate. When there is a split down the palate, it is called Cleft palate. It is not always that both the defects occur at the same time. These defects also occur separately. In their isolation they are known as isolated cleft lip or isolated cleft palate. But when these defects occur together in a child, a cut in the upper lip and the palate also failing to grow properly and forming a split, this is termed as cleft lip with cleft palate

These defects are known to be present together in varying degree in about 40 percent of the newborn babies. As per the conservative figures, it occurs with a 2:1 male-to-female ratio. Clefts can occur on one side of the mouth (unilateral) or on both sides of the mouth (bilateral). Another aspect with varying degree of inconclusive reasons to understand is that Cleft lips occur more often on the left side rather than the right side. The studies in the United States mention clefts occurring in 1 in 700 to 1,000 births, whereas children of Asian, Latino, or Native American descent suffer these defects more often

Going on in the body
Cleft lip and cleft palate develop during the pregnancy. When grooves in a developing fetus don't smooth out as it grows, the baby is born with a cleft lip. The tissues on each side of the mouth grow up to form roof of the mouth. If the tissues do not fuse normally, the baby is born with a split called cleft palate. The presence of cleft can be easily detected or diagnosed through a prenatal ultrasound, as it causes specific visible symptoms. If somehow the clefting has not been detected prior to the baby's birth, it's identified immediately afterward. There are generally three different kinds of clefts:

* Cleft palate without a cleft lip
* Cleft lip without a cleft palate
* Cleft lip and cleft palate together

Possible reasons it happens
More often a genetic link is suspected particularly when other family members also have cleft. The some of other clefts can be attributed to a cluster of health problems or certain unidentified syndromes. Most cleft lips with or without cleft palate are isolated clefts (no other medical conditions). Since clefts are formed so early in pregnancy, it is often difficult to link them to any particular causes. Some studies suggest a link between maternal drug use (such as antiseizure medication), alcohol abuse, or smoking; maternal illness or infection; or deficiency of folic acid may be related to the development of a cleft lip or palate. However, a genetic evaluation should be followed to identify the possible causes.

Plan of treatment of cleft lip/cleft palate
The very first hurdle to overcome is that of feeding the babies born with a cleft lip and or palate. Such babies may have difficulty breast-feeding or using regular nipples. A feeding specialist can help establish a successful feeding program. A Craniofacial team is formed to detect other syndromes that are commonly associated with cleft lip and palate should evaluate children born with this type of deformity. A Craniofacial team may include an oral and maxillofacial surgeon, a plastic surgeon, a pediatric dentist, an ENT specialist, a pediatrician, a speech pathologist and as well as a geneticist.

The Plastic Surgeon, who is made a part of the Cleft and Craniofacial Team, should normally be a specialist in reconstructive surgery. The team makes a comprehensive and systematic treatment plan. In most cases, reconstructive surgery is necessary to align and join these parts. It considers child’s long term developmental needs along side his immediate requirements for medical, surgical, and dental care.

Treatment options

* Nasal Alveolar Molding
* Surgery for Cleft Lip
* Surgery for Cleft Palate

Steps of treatment of cleft lip/cleft palate
It is during the first year of their life almost all children born with clefts will have to undergo surgery. Normally, the repair surgery for cleft lip is done at 3-4 months of age and for the palate repair it is done between 9-12 months. The child’s growth is observed first to arrive at actual timing for surgery as also formulating the pre-surgical treatment plan.


Pre-surgical treatment plan is referred to as Pre-surgical Nasal Alveolar Molding (PNAM). In most cases it requires fitting a dental appliance to the roof of infant’s mouth. The growth of the tissue is influenced by this pre-surgical molding and also aids in reducing the size of the opening. This process should normally begin during the first weeks of life so that the first surgery gets better results.


An observation is necessary to be made if your child is a candidate for pre-surgical nasal alveolar molding (PNAM). The pediatric dentist will do this by taking a dental impression on which he will fashion an obturator with one or two nasal prongs to help reshape the lip, nose, and palate. Pre-Surgical Nasal Alveolar Molding is a method of treatment that reshapes the infant’s nose without surgery through the use of a custom made orthopedic denture plate, which is a hard piece of plastic that fits to the roof of the mouth. The important benefit of the dental appliance is that it provides a hard surface against which infants press the nipple during feeding. This saves infant from deterioration in the general health.


The child is allowed necessary time to get used to wearing the molding, as this device is to be worn 24 hours a day. It is removed only for the purpose of cleaning. As a next step, nasal prongs are added to lift the nostril(s). In addition to it, tape is used to help move and reshape the tissue segments. The pediatric dentist will make adjustment in these devices at each scheduled visit to him. Once the dentist and plastic surgeon are satisfied with the position achieved by the tissue and cartilage that the lip is surgically repaired. Pre-surgical Nasoalveolar Molding can straighten the columella, rotate the pre-maxilla, lengthen the prolabium, aligns the alveolar ridge (gum), and lift the alar (nostril).