Cleft Lip-Palate is one of the congenital anomalies that occur during the development of the fetus in the mother’s womb. In the 4th and 6th weeks of the pregnancy process, the structure forming the lip is expected to unite. If this structure does not join, cleft lip is observed.
In the 8th-12th weeks of the pregnancy process, the structure forming the palate must come together. If this structure does not unite, cleft palate develops. In some people, both Cleft Lip and Palate Cleft may occur simultaneously.
Cleft Palate and Cleft Lip; Problems of non-union of the structure forming the palate and lip may occur in different forms.
• Unilateral Cleft Lip – Complete (full)
• Unilateral Cleft Lip – Incomplete (incomplete)
• Bilateral Cleft Lip – Complete (complete)
• Bilateral Cleft Lip – Incomplete (incomplete)
• Unilateral Cleft Palate – Complete (complete)
• Bilateral Cleft Palate – Incomplete (incomplete)
While the lip halves may be in the form of a slight notch, lip clefts extending to the lip, nose and even the palate can also be observed. Cleft lip and palate may occur due to genetic factors, or in some cases, it may occur as a module of a pregnancy-related syndrome or due to other pregnancy anomalies.
When is Lip-Palate Cleft Surgery Performed?
Cleft lip surgery in the early period (after the baby is older than 2-3 months); Cleft palate surgery, on the other hand, should be planned in the advanced period (after the baby is 6 months old). In both surgeries, the valuable criteria are that the blood costs, weight and development of the baby have reached a level that does not pose a risk in terms of surgery, and that there are no factors that may cause problems in receiving anesthesia. Alveolar cleft operation is performed at approximately 11-12 years of age.
Cleft Lip – Palate requires a new planning regarding the feeding of the baby. In the feeding process, since the sucking function will be insufficient in babies diagnosed with cleft lip and / or cleft palate; The baby should be fed with a spoon or special bottles on the lap.
In the feeding of babies with cleft palate, nutrition can be provided by using an intraoral obturator (occlusive).
Due to the negative effect of Cleft Palate on speech functions, it is valuable to correct it before speech starts (at least 18 months).
How is Cleft Lip and Palate Surgery Performed?
Cleft Lip – Palate surgery is performed under general anesthesia, in a hospital environment, by a multidisciplinary team.
The duration of the operation lasts an average of 2-3 hours, depending on the size of the cleft and the scope of the operation to be performed.
In cleft lip surgery;
• The area of cleft lip, muscles, skin and lip mucosa are repaired.
• If there are cavities extending into the nose in the inner part of the lip, they are closed,
• The opening at the base of the nose is closed,
• If there is a cleft in areas such as teeth, gums and dental beds, surgery During this time, these areas are also repaired.
Cleft lip surgery begins with an incision extending from both sides of the cleft to the nostril. The dark pink part that forms the slit is turned inside through these incisions. The cleft is repaired by closing the muscle, skin and lip mucosa respectively. Since the preferred stitches will usually be self-dissolving stitches, suture removal is not the subject of words. The lip area is closed with the help of sterile strips and dressing is done. If necessary, small tampons can be placed inside the nose.
In Cleft Palate surgery;
• Cleft palate surgery is performed using a special mouth opener.
Cleft Palate surgery begins with an incision on both sides of the cleft on the midline on the roof of the mouth. The palate is closed with the tissue brought over the cleft area, and the muscle in the soft palate is repaired.
A sufficiently long palate is formed for proper speech and swallowing. Since the preferred stitches are mostly self-dissolving stitches, suture removal is not an issue. Bleeding in the palate is controlled with a cellulose dressing pad.
After Cleft Lip-Palate Surgery
After the Cleft Lip-Palate surgery, one or two nights of hospitalization is given. In this process, the baby is supported by intravenous nutrition.
It is necessary to keep the suture and suture area hygienic after the operation, and not to insert fingers into the operation areas and mouth. Therefore, after the operation, the baby will need to wear gloves and use special armbands that prevent bending of the elbows.
In the first weeks following the surgery, attention should be paid to the program and diet recommended by your doctor on how to feed the baby, what to pay attention to, what to do for adequate fluid intake.
After cleft palate surgery, the baby should be fed on the lap and with a spoon. Care should be taken to keep the oral wound area clean by drinking water after each meal. Liquid nutrition is foreseen for an average of 2-6 weeks. After cleft lip surgery, liquid nutrition can start at the end of 1-2 days following surgery. Before the transition to liquid nutrition, which is foreseen in both surgeries, a clear diet is applied.
There is a great risk of scarring after cleft lip and palate surgery. Especially after cleft lip, scarring is inevitable. The aesthetic and plastic surgeon will plan your treatment and follow-up process in the form that will provide the optimum result in this bet.
Nasal deformation after cleft lip and palate surgery is also one of the most common complications.
