According to an estimate done by the Centers for Disease Control and Prevention (CDC), approximately 2,651 babies in the U.S. are born with a cleft palate each year. The number increases to 4,437 for babies born with a cleft lip, with or without a cleft palate.Cleft lip and palate are birth defects resulting from an improper formation of the lips or mouth during pregnancy. The lips form between week 4 and week 7, while the roof of the mouth―the palate―forms between week 6 and week 9. However, if the tissues are unable to fuse together normally due to an underlying reason, it results in the formation of a cleft. Together, these defects are called "orofacial clefts".
A baby may be born with a cleft lip, cleft palate, or both. These defects may either be isolated, or a result of other genetic birth defects. Approximately 70% of orofacial clefts are isolated clefts and can be repaired using surgical methods.
The following image explains the anatomy of a child's mouth. As you can see, there are two types of palates in the mouth―hard and soft. A cleft lip and palate repair surgery would not only restore the normal appearance of the child, but also improve his ability to speak, hear, eat, and breathe.
After evaluating the level of the defect, a team of specialists may come together and repair the clefts. Other than the need of a plastic surgeon, the expertise of a pediatrician, dentist, speech pathologist, otolaryngologist (ear, nose, and throat specialist), and hearing specialist may be required. The following sections will give you a brief idea on how the repair surgery works. Please note that these are just the initial surgeries to repair the cleft. There might be a need for follow-up surgical procedures which may continue until one's teens.
The Centers for Disease Control and Prevention recommends performing a cleft lip surgery within the first 12 months of the baby's life. Usually, a cleft lip repair is done within 1-4 months. After a thorough examination through diagnostic testing and medications, the doctor will start preparing for the surgical procedure. In some cases, the child will be required to wear an intraoral device prior to the surgery. This assists in maintaining the arch of the affected lip.
The surgery begins by administering medications which may include intravenous sedation or general anesthesia. Once the child is sedated, incisions are made on both sides of the cleft to create flaps of tissue. The goal is to use these flaps to bring the two sides together, and then finely stitch (to minimize visible scarring) the area, thus eliminating the unwanted gap.
The Centers for Disease Control and Prevention recommends performing a cleft palate surgery within the first 18 months of the baby's life. Usually, a cleft palate repair is done within 5-15 months. The procedure is comparatively more complicated than the cleft lip surgery, since the muscles and the tissues of the palate need to be carefully repositioned in order to fill the gap. The palate also plays a significant role in the speech development of the baby, therefore, extra caution is necessary.
The procedure begins by making incisions on both sides of the cleft palate, followed by repositioning the components of the palate―muscles and the hard and soft palates. Once the repositioning is done, the area is sewed together using absorbable sutures.
Note: The scars will be formed on the contour of the lips, and may fade as the child grows, but they will always be noticeable. However, depending upon the case, follow-up surgeries may be required, which may continue well into a child's teens, or even adulthood.
After the surgery is completed, the child may be required to stay at the hospital for about 5 to 7 days. The doctor or the staff nurse will give you elaborate instructions regarding aftercare. This includes: Change in dressing, application of medications, feeding techniques, and other precautions to minimize the risk of infection in order to aid quick healing. The following sections will give you a brief idea of what is expected from you as a parent, when it comes to taking care of your child post surgery.
To start with, it is very important to ensure that the operated site is kept clean. Usually, some drainage is observed from the mouth and nose of the child during the first week after surgery. Because the incision is still fresh, the following measures are advisable.
- Always use a Q-tip cotton swab to clean the wound, using the special liquid given by the doctor for cleaning purposes.
- Start with the area that is closer to the nose, and clean away from the wound in small circular motions.
- Ensure that you do the cleaning with light pressure, and apply the suggested antibiotic ointment(s) as soon as the site becomes dry.
- Do not remove the stitches on your own. Schedule a timely follow-up visit with the doctor.
To minimize contact with the operated area, put the child on a liquid diet. Children who do not drink breast milk or formula should be given food in pureed form for a couple of days post surgery. The doctor may advice the following measures for proper feeding.
- During feeding, ensure that the baby is sitting in an upright position.
- Ask your doctor regarding the ideal type of bottle to be used for feeding purposes.
- If the child eats solid foods, ensure that these food items are pureed.
- Avoid using sharp utensils such as forks, knives, or chopsticks while feeding your child. Use a cup or a spoon.
- Certain food items such as solid food chunks, gum, seeds, nuts, cream, butter, pastries, popcorn, or any crunchy/sticky food items should be avoided.
- Ensure that you clean the incision site post feeding to minimize the chances of an infection.
It is important to ensure that the area is not exposed to any form of physical stress in the first 3 to 4 weeks. Because children tend to use their hands to put toys or their thumbs in the mouth, the doctor may put arm restraints on the child to avoid unwanted contact. The restraints may be removed several times during the day, however, one needs to be sure that the child doesn't touch the incision at all while freed from the splints.
- Remove the arm cuffs 2 or 3 times in a day, ensuring that only one is removed at a time.
- Ensure that the child's arms or hands do not touch the incision.
- While placing the cuffs back on, inspect the area to ensure no soreness/redness is present on the skin.
- Your doctor will inform you about when you can stop using restraints.
- Avoid involving your child in activities such as swimming, jumping, playing in the sun, and other activities that may affect the healing process.
Complete recovery may take up to 4 weeks or more, till the swelling subsides. There is a need to be in touch with your doctor on a continuous basis to see how the healing is progressing. The assistance of additional experts may be required to ensure a productive outcome from the surgery. These are mentioned below.
- Speech therapy may be required for about 2 months to help the child overcome his speech problems.
- An orthodontist's expertise is required to ensure palatal expansion (if needed), to normalize the width of the palate as the child grows. Overall dental care is much-needed to minimize oral health problems.
- Plastic surgery may be required as the child grows to improve the appearance of the facial area including the nose and upper lip.
Disclaimer: This Buzzle article is for informative purposes only, and should not be replaced for the advice of a medical professional.