Pediatric Plastic Surgery

Cleft Lip and Palate

The palate or roof of the mouth is made up of two parts, the hard palate (the front bony part of the mouth, behind the front teeth) and the soft palate (the fleshy, flexible part at the back of the mouth). The palate is formed in the sixth to ninth week of pregnancy, while the lips are formed during the fourth and seventh week. Cleft lip and cleft palate, referred to as orofacial clefts, are the most common birth defects that occur when your baby’s lip or palate do not form completely, leaving a physical gap or split in the lip or palate.

Symptoms

The cleft lip may be seen as a small notch on the upper lip or a large opening that extends all the way to the nose. A cleft palate can involve a part of the palate (hard palate) or can extend to the back of the mouth (hard and soft palate). A cleft lip or a cleft palate can lead to problems with feeding, talking and hearing. They can also increase the occurrence of ear infections and dental problems.

Types

Clefts can be categorized into the following types:

  • cleft lip, but no cleft palate
  • cleft palate, but no cleft lip
  • cleft lip and a cleft palate
  • unilateral clefting: cleft on one side of the mouth
  • bilateral clefting: cleft on both sides of the mouth

Causes

The exact causes of these birth defects remain unknown. The defects may be inherited or associated with certain environmental factors during pregnancy such as:

  • Influence of certain medicines (certain drugs to treat acne, psoriasis, cancer, and seizure)
  • Lack of a proper diet
  • Exposure to certain chemicals or viruses
  • Smoking during pregnancy and diabetes before pregnancy

Diagnosis

Most cases of cleft lip and palate are visible at birth and don't require any special tests for diagnosis. However, these defects can be diagnosed using an ultrasound in the developing foetus as an abnormality in the facial structures, but diagnosing a cleft palate is difficult as the roof of foetus' mouth cannot be viewed properly.

Treatment

Cleft lip and palate can be repaired or closed using specialized plastic surgery techniques. Cleft lip surgery is usually performed between 6 to 12 months of age and cleft palate surgery between 6 to 18 months of age. The aim of surgery is to improve your child’s ability to eat, speak, breathe and hear, and to restore a more normal appearance, structure and functioning of the lips and mouth.

Cleft lip surgery: This surgery is performed under general anaesthesia (where your baby is asleep). The surgeon makes incisions on both sides of the cleft so as to detach the muscle and the tissue around it. The tissue and muscle is rearranged and both sides of the lip are stitched together to close the cleft. The detachment and repositioning of the muscle during the surgery recreates the circular muscle around the mouth, thereby restoring the normal appearance and function of the lip. Reconstruction of the nose may also be required during cleft lip surgery to provide additional support for the nose.

Cleft palate surgery: This surgery is performed under general anaesthesia. Your surgeon makes incisions on both sides of the cleft, brings the tissue and muscles around the cleft together, and stitches the cleft to close it. During the surgery, the muscles of the soft palate are repositioned to provide more effective speech.

Small sutures are used for both procedures to minimize the surgical scar to the maximum extent. The stiches are absorbed as the tissue heals. These surgeries would require follow-up procedures to improve on the initial outcomes of appearance and function. Additionally, dental and orthodontic surgeries, and speech therapy may also be required as your child grows.

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