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Cleft Lip & Palate Surgery

A cleft lip is a birth defect:

  • A cleft lip may be just a small notch in the lip. It may also be a complete split in the lip that goes all the way to the base of the nose.
  • A cleft palate can be on one or both sides of the roof of the mouth. It may go the full length of the palate.
  • Your child may have one or both of these conditions at birth.

Most times, cleft lip repair is done when the child is 6 to 12 weeks old.

Hospital Stay: Hospital Stay: 4 days
Duration: Duration: 2-6 hrs
Cost Estimate: Cost Estimate: 4700 USD - 6800 USD These are indicative prices in Indian Hospitals

A cleft, or separation of the upper lip and/or the roof of the mouth, occurs very early in the development of the unborn child. During fetal development, certain components of the upper lip and roof of the mouth fail to form normally. Cleft lip and cleft palate repair is a type of plastic surgery to correct this abnormal development both to restore function and to restore a more normal appearance.

Most clefts can be repaired through specialized plastic surgery techniques, improving child’s ability to eat, speak, hear and breathe, and to restore a more normal appearance and function.

Risks of repair
Problems these surgeries may cause are:

  • The bones in the middle of the face may not grow correctly.
  • The connection between the mouth and nose may not be normal.

Before the Procedure

You will meet with a speech therapist or feeding therapist soon after your child is born. The therapist will help you find the best way to feed your child before the surgery. Your child must gain weight and be healthy before surgery.

The child’s surgeon may ask for:

  • Blood investigations
  • Take a complete medical history of the child
  • Do a complete physical examination of the child

Always tell child’s doctor or nurse:

  • What drugs are being given to the child
  • Include drugs, herbs, and vitamins you bought without a prescription

During the days before the surgery:

  • About 10 days before the surgery, you will be asked to stop giving your child aspirin, ibuprofen, warfarin and any other drugs that make it hard for your child’s blood to clot.
  • Ask your child’s doctor which drugs the child should still take on the day of the surgery.

On the day of the surgery:

Most times, your child will not be able to drink or eat anything for several hours before the surgery.

  • Give your child a small sip of water with any drugs your doctor told you to give your child.
  • Your child’s doctor or nurse will tell you when to arrive for the surgery.
  • The doctor will make sure your child is healthy before the surgery. If your child is ill, surgery may be delayed.

Surgery:

  • For cleft lip surgery, the child will have general anesthesia. The surgeon will trim the tissues and sew the lip together. The stitches will be very small so that the scar is as small as possible. Most of the stitches will absorb into the tissue as the scar heals, so they will not have to be removed later.
  • Most times, cleft palate repair is done when the child is older, between 9 months and 1 year old. This allows the palate to change as the baby grows. Doing the repair when the child is this age will help prevent further speech problems as the child develops.
  • In cleft palate repair also the child will have general anesthesia. Tissue from the roof of the mouth may be moved over to cover the soft palate. Sometimes a child will need more than one surgery / staged procedures to close the palate completely.
  • During these procedures, the surgeon may also need to repair the tip of child’s nose, called rhinoplasty.

After the Procedure

Your child will probably be in the hospital for 5 to 7 days right after surgery. Complete recovery can take up to 4 weeks.

The surgery wound must be kept very clean as it heals. It must not be stretched or have any pressure put on it for 3 to 4 weeks. You will be taught how to take care of the wound. You will need to clean it with soap and water or a special cleaning liquid, and keep it moist with ointment.

Until the wound heals, your child will be on a liquid diet. Your child will probably have to wear arm cuffs or splints to prevent picking at the wound. It is important for your child not to put hands or toys in the mouth.

Outlook

Most babies heal without problems. How your child will look after healing often depends on how serious the defect was. Your child might need another surgery to fix the scar from the surgery wound.

A child who had a cleft palate repair may need to see a dentist or orthodontist. The teeth may need correcting as they come in.

Hearing problems are common in children with cleft lip or cleft palate. Your child should have a hearing test early on, and it should be repeated over time.

Your child may still have problems with speech after the surgery. This is caused by muscle problems in the palate. Speech therapy will help your child.

A cleft lip is an opening extending through the upper lip. It may be in the center or left and/or right side of the lip. A cleft palate is an opening of the hard palate, the bony front portion of the roof of the mouth or the soft palate, the muscular non-bony region in the rear of the roof of the mouth. Similar to a cleft lip, a cleft palate may be midline and/or to either right of left side of the palate. A cleft palate may extend from the upper jawbone to the rear of the throat.

Since development of the lip and palate occur at different times during gestation, an infant may have either a cleft lip or cleft palate or clefting of both regions.

There are a number of complications that may affect infants and children with cleft lip and palate. These include the following:

  • Feeding problems: Because of the anatomical defects, it may be very difficult for newborn infants to breastfeed successfully. The abnormal separation of the upper lip makes it very difficult for the newborn to obtain a good seal that is necessary for a successful nursing experience. Specialized bottles and nipple systems that facilitate effective nutrition may be needed. Those children with a cleft palate are commonly fitted with a removable artificial palate very early in life. This device limits the possibility of passage of liquids through the defect into the nostrils as well as also facilitating the ability to efficiently suck on the specialized nipple.
  • Ear infections/hearing loss: Children with cleft palate are more likely to have recurrent ear infections and associated fluid accumulation in the inside of the eardrum. In order to limit these issues, most children with cleft palate have tubes placed through the eardrum during their early months.
  • Speech problems: The malformations associated with cleft palate and lip may impact articulation of speech. The most common issue tends to be a nasal quality to their voice. Corrective surgery may lessen these speech issues but most children with cleft lip and/or palate benefit from formal speech therapy.
  • Dental problems: Children with cleft lip and/or palate commonly have issues with missing and malformed teeth and commonly require orthodontic treatments and occasionally oral surgery if the upper jawbone has improper placement and abnormal positioning of permanent teeth.
  • Several years of multiple surgical procedures are generally necessary to provide a satisfactory outcome.
  • The repair of a cleft lip is usually addressed at approximately 3 months of age. One or two surgical procedures may be necessary to achieve both effective lip function and cosmetic repair.
  • Cleft palate repair is a multistep series of surgical procedures starting at about 6 to 12 months of age and finalized in the later teen years. The first procedure is typically repair of the defect in the palate, which allows better feeding and weight gain and reduces the frequency of hearing loss and recurrent ear infections. Repair of the palate defect also encourages appropriate development of the upper jaw and other facial bones. At approximately 8 years of age, a bone graft is performed to further support the upper jaw structure and aid in speech articulation.
  • Braces are generally required to straighten permanent teeth and plastic surgical scar revision is done after the majority of adolescent growth has occurred.

While the effective treatment for cleft lip and cleft palate requires many surgical procedures, speech therapy, and consultation with many medical specialists, it should be anticipated that an excellent outcome regarding appearance and function can be achieved.

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