cleft lıp and palate OPERATION and TREATMENT
Author: Assoc. Prof. Burhan Özalp, MD Category: General Issues 0 Comment
Cleft lip and palate is the result of the incomplete convergence of the lip and palate in the child developing in the womb during pregnancy. These splits can be either single or double-sided and are also classified as complete or incomplete according to whether all the structures join the split. Sometimes the condition of muscles failing to fully join together under the mucosa, called submucosal cleft, can be seen, and sometimes there is a split in the uvula. If not treated, cleft lip and palate can cause nutritional deficiencies, speech disorders and recurrent inflammation of the middle ear (otitis media). Therefore, cleft lip and palate patients are candidates for the multidisciplinary treatment, including the plastic surgeon, the ENT specialist, the psychologist, the speech therapist, the paediatrician, and the nurse.
It is more common in men and on the left side. Its frequency varies from society to society. There is familial inheritance and if the first child has a palate-lip cleft, the risk in the next child increases considerably.
The genetic transition in the causes of the cleft lip and palate is quite evident and may occur as a component of some syndromes. It is known that alcohol, insulin, corticosteroids, anti-epileptic drugs, oxygen deficiency are the main factors that trigger the anomaly.
Lip clefts can be operated from 3 months of age, and cleft palate from 1 year of age. Particularly in the cleft palate, a certain weight and blood value are awaited to be reached.
cleft lıp and palate OPERATION METHOD
In lip clefts, skin and muscle tissues, which are lifted from both sides of the cleft, are moved through the midline and the lip repair is performed. A scar is always left at the end of the operation. In addition, notching at the lip border, asymmetry, failure to close the base of the nose fully can be stated among possible outcomes.
In palate clefts, the muscles underneath the palate mucosa are separated from the places where they cling abnormally and are fixed at the midline with stitches to correct swallowing and speech functions. In addition, the parts facing the nasal and oral cavity are closed with excess mucosa obtained by pulling the lip mucosa from the sides towards the midline.
Again immediately after the operation, the diet is supplemented with serum and the child’s hand is prevented from being taken to the mouth.
If there is stretched closure after palate cleft surgery, and if the doctor’s directives have not been fully followed, reopening, called fistula, can be seen. Minor corrective surgery, called revisions, may be needed in lip clefts.
Nutrition with transparent liquids in the first week following the operation then progressively turns into normal nutrition. Speech therapy is needed after repair of the palate cleft.
Children with lip and palate clefts are then operated at least 2 times for the completion of the missing bone in the jaw bone and for the correction of the nose.