The condition known as cleft lip and palate deformity is seen in 1/1000 births on average and it is seen that the baby is 8-12. It is an anomaly that occurs due to developmental disorders that can be seen in weeks.
The biggest problem seen in babies born with this anomaly in the early period (first months after birth) is the slow development of these children due to feeding difficulties and frequent upper and lower respiratory infections. This anomaly, which is quite common, can be completely corrected by a good and orderly multidisciplinary team approach and children born with this anomaly have a completely normal life.
The causes of cleft lip and palate were examined in detail and both genetic and environmental factors were found to play a role in its formation. Genetic factors play a role in 5-10% of all clefts. If the family has cleft lip and palate anomalies, the risk of being in the baby increases. If there is no such history in the family, it may occur with cleft mutant genes and chromosomal deletions or isolated genetic anomalies with syndrome anomalies such as trisomy D and trisomy E. Environmental factors play a more effective role in cleft formation and often there is no specific cause. Experimentally, high doses of cortisone may cause cleft lip and palate formation in offspring of pregnant animals. Again, a rubella infection that the mother will have during the first 3 months of pregnancy causes cleft formation. Smoking and some vitamin deficiencies have also been shown to have an effect on cleft formation. In addition, when the socioeconomic level is low, the risk of cleft lip and palate is higher. In many cases of the parents especially the mother in the formation of cleft lip and palate does not have any blame. Since giving birth to such a child after birth, parents often blame each other and themselves, but such an approach is not correct and has no positive effect on the treatment of the child.Epidemiology
Cleft lip and palate roughly:
1. Pure lip cleft: 25%
2. Pure cleft cleft: 25%
3. Cleft lip and palate together: 50%.
The cleft lip and palate is seen at 1/1000 births, while the cleft palate is 1/2500 and the cleft palate is twice as high in males while the cleft palate is twice as high in girls. The reason for this is that the mesodermal protrusions in the mouth are merged in the embryonic period, which is 1 week later in the infants, and if these mesodermal protrusions do not coincide, cleft palate will occur.
Anatomy of cleft lip and palate anomaly:
Cleft lip anomaly is seen in the upper lip.
- One-sided incomplete cleft
2. One-sided complete lip cleft
3. Two-sided incomplete lip cleft
4. One-sided complete one-sided incomplete lip cleft
5. Two-sided full lip cleft
6. Midline lip cleft (rarely seen) )
- Soft cleft palate
2. Hard cleft palate
3. Submucosa cleft
4. Bifid appears as uvula. (division of small language into two)
These are generally cleft lip and palate classifications that should be known by families. Plastic surgeons use a more anatomical classification.
Cleft Lip Treatment
Surgical repair of the cleft lip aims to normalize the anatomy of the facial contours. Since the lip is both a cosmetic and functional organ, the result should be both cosmetic and functional. Since nasal deformity will always be seen in cleft lip cases, the aim is to create symmetrical lip mucosa and skin together with the working lip muscles, and to create an aesthetically pleasing cupid spring and cupid bow with vermillion tubercle. Symmetry of the nostrils, a sufficient nasal cushion and a sufficient nasal tip projection with a length of columella and symmetrical nasal wings are the purposes of nasal treatment.
In fact, it is more accurate to say that it is time to start treatment rather than the age of operation. Treatment of cleft lip and palate babies starts the first 48 hours after birth. Some surgeons perform the cleft lip surgery in the first week after birth, while some surgeons perform this operation in the 2-6th postnatal period considering the development of the child. between months. Some surgeons perform a temporary lip operation before the actual lip operation and prepare the anatomical structures of the baby for the actual operation (lip adhesion). These methods generally do not differ greatly from each other. The Plastic Surgeon prefers whatever teaching he has received during his training. Families do not need to worry about this. On the other hand, regardless of the level of deformity, it should be evaluated by an orthodontist immediately after birth and anatomic structures should be developed regularly with various intraoral or extraoral devices according to the type of deformity. In the Far East, where this deformity is common, preoperative orthodontic treatment is very well applied, but unfortunately it is only provided in certain centres in our country. In addition, these babies should be examined by a paediatrician immediately after birth and any additional anomalies should be investigated. Parents should also be provided with psychological support (especially if no prenatal cleft lip and palate diagnosis has been made). Since the sucking function is not sufficient in these babies, the mother is told about the feeding style of the baby (on the lap and spoon or with a special bottle and using an oral obturator in the cleft palate).
It is a bit more difficult to perform the surgery in the first week. Because the baby is not stable during this period and carries risks in terms of anesthesia. In addition, the lip structure is not yet large enough to perform an operation on them is quite difficult. Babies with cleft lips are mostly operated in 2-3 months after birth. It is important that the weight of the baby increases gradually before the operation. In infants with poor development, it is best not to perform surgery until the problem is corrected. Pre-operative tests of the baby should be performed to show that blood values such as hemoglobins, hematocrits, bleeding clotting time are at normal levels. Since these cases are always operated under general anesthesia, it is imperative that the baby is prepared before surgery.
Cleft Lip Postoperative Care
Patients are usually kept in the hospital on the day and night of surgery and are sent home the next morning. Feeding of the babies is in the form of sitting in a sitting position with a spoon starting from the day of surgery. Contamination of the incision lines with nasal discharge and food should be prevented. For this purpose, the incision is dressed daily with antibiotic pomades. It is important to keep the wound lines dry. Postoperative 5-7. All sutures are taken on days.
Cleft Palate Treatment
The anomaly present in the cleft palate varies from full slits where the mouth and nose cavities open to each other, from cleft only in the arch of the tooth and only in the soft palate or small tongue. A situation in the cleft palate is submucose cleft. These slits can only be identified by plastic surgeons and are a mucosal curtain between the nasal and oral cavities. However, because the muscles are separated from each other under this mucosa, rhininolalia apart or cleft palate speech is the ım hmm hmm ”speech that comes out of the nose. Although there is no visible cleft in these babies, the repair of the submucosa cleft is necessary for the baby to have a proper speech in the future.
Objectives of cleft palate:
- Forming an air and waterproof velopharyngeal valve
2. Preservation of hearing
3. Preservation of mid-face growth
4. Functional and aesthetically adequate upper tooth arch
5. Providing smooth speech in the future.
In babies with cleft palate only, treatment starts with orthodontic treatments in the first 48 hours after birth. Various intraoral appliances reduce the cleft to facilitate further surgery. As in lip surgery, the age of the operation in the palate surgery is different in various teachings. One group considered the age of treatment as appropriate for the sixth month, while one group considered the age between 12-18 months as appropriate. These are merely academic debates, as demonstrated in various researches, and each group asserts that their own surgery is better. The operation is not very important if it is done well. Nevertheless, the majority of plastic surgeons suggest that they should wait at least 9 months for surgery.
Cleft Palate Postoperative Care
Postoperative care is more important and difficult in cleft palate than in cleft lip. There may be an intra-oral leakage from the early postoperative period, and this bleeding should be closely monitored as it may cause asphyxia. Likewise, a swollen tongue can escape and cause suffocation. In the early period and at least the first 48-72 hours, the infant’s food should not be particulate and should receive clear food. Although initially difficult to maintain, incisions in the mouth heal rapidly within 3-4 days.
Cleft lip and palate surgeries are performed by plastic surgeons. In the cleft lip and palate surgeries, the expectations of the family are completely flawless and there is no scar (scars) on the face, a normal nose and cleft lip and a non-palate child can talk, but the results are far from perfect. It is inevitable that scars remain in the cleft area, especially after lip surgery. Nasal deformities occur in patients and these deformities need aesthetic nose surgery after development is completed (17-18 years). The closure of the palate may not be complete and patients may have symptoms such as speech defects, food coming from the nose, and patients may have to use a palate prosthesis. Since many patients do not have the chance to obtain orthodontic treatment immediately after birth, the likelihood of such complications increases. However, parents should be aware that these children are completely normal (except for their deformities) and not abnormal children.
There is no alternative to cleft lip and palate surgery. These surgeries provide functional and aesthetic improvement of the child. Surgery should be performed at the age recommended by your doctor. Delay or premature delivery can lead to various functional and aesthetic problems. There is no functional or aesthetic disorder even if you do not perform surgery in limited cases where only the bifid uvula is called and the cleft is only in small tongue. In such a deformity, the decision can be left to the family and the general health status of the patient is examined.