Cleft Lip and Palate Repair
What Is A Cleft Lip And A Cleft Palate?
A cleft lip, or harelip, can either be a small notch or a whole split in the top lip. In some cases it can extend right up to the nose. If this is the case, rhinoplasty may be required. A cleft palate can be a hole in one or both sides of the roof of the mouth. In extreme cases the entire roof of the mouth can be missing. This happens because the two plates in the skull that form the roof of the mouth have not joined up properly. Both these ailments are birth defects. Approximately 1 in 700 children are born with one or both of these problems. Due to these defects, children have trouble feeding, may have hearing difficulties and some require speech therapy in later years. With the help of surgery both these ailments can be rectified.
Symptoms of Cleft Lip and Palate
There are two types of cleft lip – a unilateral cleft, a deformation that affects just one side of the lip, and a bilateral cleft, which occurs when the cleft affects both sides.
A cleft lip and/or palate are visibly noticeable at birth, although a submucous cleft palate is not so easily spotted, as the roof of the mouth can conceal it. As a result, it may go unnoticed for several months or in rare cases, years. The appearance of a visible cleft lip will vary depending on it’s severity. You may notice a small notch in the lip, known as an incomplete cleft, or you may see a wide gap that runs from the lip to the base of the nostril. This is known as a complete cleft lip, and will require surgery to rectify. A cleft palate however, is not as readily visible as a cleft lip. As it can affect the hard and soft palate and therefore involve the roof of the mouth, it can be concealed inside the mouth and therefore hard to see. However, babies with a cleft palate normally experience difficulties latching and feeding, and so a doctor may examine and discover a cleft palate if this is the case.
If your baby is having difficulty feeding, or if there is milk escaping from the nose during feeding, you should contact your health care provider and arrange an examination to rule out the possibility of cleft palate. In older children, things such as an inability to use a straw (lack of suction), difficulty blowing out candles (lack of pressure) and nasally-toned speech may also indicate cleft palate.
Pierre-Robin Syndrome, also known as a Pierre-Robin cleft palate, occurs when children have a retruded or set back lower jaw. This can cause the tongue to interfere with the air entering the upper airway, resulting in noisy or labored breathing. This can be repaired with surgery, which normally occurs later than would corrective surgery to treat a cleft lip or palate.
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Causes of Cleft Lip and Palate
There can be a number of reasons why a cleft palate occurs. Research has shown that inherited genes can potentially cause a cleft lip or palate to develop, while there are also a number of environmental factors that can heighten the risk. During pregnancy, women are advised to take folic acid supplements, as this can help lower the risk of birth defects occurring. While there’s no scientific evidence to prove that a lack of folic acid contributes to the formation of a cleft lip, health professionals advise that women that have a family history of cleft lips or palates take a heightened dose of this supplement during pregnancy.
Certain behaviours such as alcohol consumption and smoking can also increase the risk of a cleft deformation. First-hand smoke has been known to cause health defects, and while the effects of second-hand smoke are not as well documented, pregnant women are advised to avoid inhaling it while pregnant. Alcohol consumption can cause fetal deformations, with alcohol consumed in excess resulting in Fetal Alcohol Syndrome (FAS). Some studies have confirmed a correlation between an expectant mother's alcohol consumption and the formation of a cleft lip or palate.
Obesity and overall health also plays a part in the health development of a fetus. Obese mothers, or women with poor nutrition and eating habits, are at higher risk of having a baby with a cleft lip or palate. It has also been suggested that certain medications, such as those to treat conditions such as acne, psoriasis, arthritis and some forms of cancers, can also heighten the risk of cleft lip and palate.
If you have any concerns over the development of your baby and the risk of cleft lip or palate occurring, speak to your GP or midwife to discuss preventative measures to take throughout your pregnancy.
Cleft Lip Repair Surgery
In most cases when cleft lip surgery is required it is performed between 6 and 12 weeks after birth. It is necessry for a general anaesthetic to be used so the child is asleep and cannot feel any pain. The surgeon then trims the tissue in the top lip and then sews the lip together. Tiny stitches are used to reduce any scarring and these stitches should dissolve. This way the child will not need to have them removed, reducing any further distress to the child.
Cleft Palate Repair Surgery
This type of surgery is done when the child is a little older, usually between 9 and 12 months after birth. The surgery is done at this age to allow the palate to alter with the childs growth. Surgery at this age will help prevent further issues as the child grows up such as speech impediments. When cleft palate repair is required a general anaesthetic is used, again to ensure the child is asleep and pain free. The tissues from the roof of the mouth are used to close the hole in the palate. If the hole is large or there is more than one, more surgery will be needed to close the palate fully.
Aftercare And Outlook After Surgery
After surgery has taken place the child will need to remain in hospital for up to 1 week. Complete recovery can take up to 1 month. After both types of surgery the wound must be kept clean. A special type of cream will need to be administered to the wound. In some cases the child will be required to wear arm splints to stop the child putting anything hard in their mouths such as toys. Almost all children heal with no problems. Sometimes though the child may have to have further corrective surgery to rectify any scarring. Depending on how severe the cleft palate was to begin with, some dentistry work may be required as the child gets older. Speech therapy is also needed sometimes as the muscles of the mouth may have been affected. Hearing problems are also common in children with cleft lip or cleft palate so this should be monitored over time. As the child grows up, full recovery is achievable.