Cleft Lip and Cleft Palate

Cleft Lip

A cleft lip, which is defined as a congenital anomaly, is a condition that occurs between the first 4-8 weeks of pregnancy due to the inability of the structures to form the lip and face. Familial predisposition may increase the risk of this problem, which is one of the most common congenital anomalies.

Cleft Palate

The cleft palate, which is a congenital anomaly, is also a problem arising from the inability to combine the structures that will form the palate around the 12th week in the womb. Familial predisposition for cleft palate, which can occur in all races, increases the risk of occurrence.

Although it is sad for the parents that their baby was born with this anomaly, it should not be forgotten that the problem of cleft lip and cleft palate can be corrected.

What are the Types of Cleft Lips?

• Microform cleft: In this type, there is a small notch in the lip.
• Incomplete (unilateral or bilateral): These clefts form clefts where the base of the nose is not fully included.
• Complete (single or bilateral): These are clefts that also cover the base of the nose.

What Are the Types of Cleft Palate?

• Complete: a condition in which the soft and hard palate are affected together.
• Incomplete: clefts in which only the soft palate is affected.
• Bilateral clefts: a condition in which the structure called vomer has clefts on both sides.
• Submucous cleft: a condition in which there is no cleft when viewed from the outside, but the muscles do not join.

What are the Causes of Cleft Lip and Cleft Palate?

In the second and third months of the pregnancy period, the tissues forming the lip and palate under normal conditions fuse together. However, in babies with cleft lip and cleft palate, this process either does not occur at all or occurs incompletely. However, there is no definite factor known to cause this condition. It is thought to be caused by genetic and environmental factors. As a result, any condition that may affect the development of the fetus in the womb, such as heredity, infections, drug use, smoking, alcohol, and radiation, can be the cause.

At What Age Should Cleft Lip and Cleft Palate Treatment Be Started? How Is Cleft Lip Treatment Performed?

Treatment starts as soon as the child is born. First of all, a detailed examination by the Pediatrics Specialist and then genetic analyzes are performed. It is extremely important to start orthodontic treatment for a cleft lip immediately. In addition, these babies should be followed closely in terms of weight gain, nutrition, and development. After the necessary preparations are completed, surgical treatment is applied.

At What Age Are Cleft Lip and Cleft Palate Surgery Performed?

Although it is necessary to take action as soon as the baby is born for the treatment of cleft lip, the operation should be performed around the age of 3 years. The "rule of 10s" should be taken into account when deciding on surgery. In other words, if the baby's weight is over 10 pounds (about 4-4.5 kg), the age is at least 10 weeks, and the blood iron level (hemoglobin) is over 10 g/dl, there is no harm in performing surgery.

The appropriate period for cleft palate surgeries is between 9-12 months of the baby.

How Is Cleft Palate Surgery Performed?

Although there are different techniques, it is done by pulling the tissues from the edges to cover the cleft in the middle. The basis of the operation is flapping surgery. It is important that the rotation is done without disrupting the blood supply of the tissues. Repairs are carried out in 3 layers. When viewed from the inside of the mouth, first the nasal side (nasal floor) is repaired, then the muscle repair is performed as it should be, from where the palate muscles, which provide the main speech function, are attached incorrectly. Finally, the most superficial part, the intraoral mucosa, is repaired. The remaining openings at the edges will close on their own over time. In addition, necessary controls are made by otolaryngologists before the operation in these children, and if necessary, a tube can be inserted in the same surgery.

How Should the Care After Cleft Lip Surgery Be?

Since the child is still very young, important duties fall on the parents after the operation. In this process, it is important not to make the child cry and to provide the nutrition as described as soon as possible. Being close to the mother will calm the child. Also, intermittent steam applications can be beneficial for those with nasal congestion. It is important that the child is prevented from reaching the stitches and that they are properly dressed.

How Should the Care After Cleft Palate Surgery Be?

After cleft palate surgeries, tongue edema, breathing problems, or short-term bleeding in the mouth may occur. For this reason, it is necessary for the parents to be in close contact with the child in the first 24 hours and to keep him/her under observation. It is important for the child to take plenty of water in the first 24 hours and cleaning of the mouth and feeding should be provided. If necessary, support can be given through vascular access. Steam can also be used to relieve breathing. After the third day, he/she can start to take drinks such as soup and juice. A gradual transition to solid food can be achieved and after 3-4 weeks the child will be able to feed as before.