Cleft lip and 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 should come together. Cleft palate develops if this structure does not unite. In some people, both Cleft Lip and Cleft Palate can occur at the same time.
Cleft Palate and Cleft Lip; Problems of non-union of the structure that makes up the palate and lip can occur in different ways.
Unilateral Cleft Lip – Complete (full)
• Unilateral Cleft Lip – Incomplete (incomplete)
• Bilateral Cleft Lip – Complete (full)
• Bilateral Cleft Lip – Incomplete (incomplete)
• Unilateral Cleft Palate – Complete (full)
• Bilateral Cleft Palate – Incomplete (incomplete)
As the lip halves can 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, as well as in some cases as part of a pregnancy-related syndrome or due to other pregnancy anomalies.
When is Cleft Lip and Palate Surgery Performed?
Cleft lip surgery in the early period (after the baby is older than 2-3 months); Cleft palate surgery is ideal to be planned in the future (after the baby is 6 months old). In both surgeries, the important criteria are that the blood values, weight and development of the baby have reached a level that will 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 and 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).
Because of the negative effect of cleft palate on speech functions, it is important to correct it before speech starts (at the latest 18 months).
How is Cleft Lip and Palate Surgery Performed?
Cleft lip and palate surgery is performed under general anesthesia, in a hospital setting, by a multidisciplinary team.
It takes an average of 2-3 hours depending on the duration of the operation, the size of the cleft and the scope of the operation to be performed.
In cleft lip surgery;
• The area where the cleft lip occurs, the muscles in the area, the skin and the 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 are clefts in areas such as teeth, gums and dental beds, these areas are also repaired during the surgery.
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 sutures are usually self-dissolving sutures, there is no suture removal. 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 palate of sufficient length is formed for proper speech and swallowing. Since the preferred sutures are usually self-dissolving sutures, there is no suture removal. Bleeding in the palate is controlled with a cellulose dressing pad.
After Cleft Lip and Palate Surgery
After cleft lip and palate surgery, hospitalization is given for one or two nights. 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 surgical sites and mouth. For this reason, it will be necessary to wear gloves and use special armbands that prevent bending of the elbows after the surgery.
In the first weeks following the surgery, attention should be paid to the program and diet recommended by your doctor on issues such as how the baby will be fed, what should be considered, what should be done 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.
After cleft lip and palate surgery, the risk of scarring is high. Especially after cleft lip, scarring is inevitable. The aesthetic and plastic surgeon will plan your treatment and follow-up process to provide the optimum result in this regard.
Nasal deformation after cleft lip and palate surgery is one of the most common complications.