Cleft palate and lip deformity is one of the important concerns that expectant couples have in mind. The most important reason for this is that it is known that the frequency of the appearance is high as well as the excess of appearance disorder. Parts of the face consist of structures called pharyngeal curvatures during the early weeks of a baby’s life in the mother’s womb. These structures form separately on both sides and combine in the middle to form the head and face region. If this union is left unfinished for any reason, appearance defects called facial clefts occur. The last structures to realize this merger in the midline are those that make up the lip and palate. For this reason, the anomalies that we have classified under the name of facial clefts are most frequently seen in the palate and lip.
In rare cases, in about 1 in every 800 babies born, these body parts fail to fuse. The absence of fusion in the upper lip and the formation of a cleft in the middle is called “cleft lip”. The case of a cleft in the roof of the mouth or palate as a similar congenital anomaly is called “cleft palate”. Since the lip and palate tissues develop in different stages, cleft lip, cleft palate or both may occur in children. Cleft lip anomaly is also called rabbit lip in daily life.
Environmental and genetic factors act together in the formation of cleft lip and/or cleft palate deformity. It is not correct to blame any single cause alone. Children of people with this deformity in a family or pedigree are more likely to have a cleft palate or lip. Again, if one of the children has it, the risk of being seen in the second baby is high, if one of the parents and the child have it, the probability of it being seen in the new baby is much higher. Apart from genetic reasons, even if this anomaly is not in the family, there is a possibility of cleft lip-palate.
A baby born with a cleft palate and cleft lip anomaly cannot fully perform the sucking function, so feeding becomes a problem. It is more vulnerable to upper respiratory tract infections and otitis media and can get sick frequently, sometimes with more severe cleft anomalies in the head and face region. If this problem of a baby with a cleft palate is still not resolved correctly when he reaches the speech period, or if he has not had any surgery until this period, he cannot fully learn to speak. In such children, since the soft palate cannot fully separate the mouth and nose region from each other during speech, the sounds seem to come out of the nose. This speech is called “nazone speech” or nasal speech. Again, depending on the severity of the deformity in the lip, there may be deformities in the nose.
If your child was born with a cleft lip, cleft palate or both, the treatment of this is surgery that should be done at appropriate times with the right method. At the same time, it is necessary to plan and manage correctly before and after the operation. The most important problem that the family should pay attention to before the operation is the feeding of the child, they frequently encounter aspiration of food since they cannot fully absorb the sucking function. Feeding the baby with a spoon or a special bottle by keeping the baby at an inclination of at least 45 degrees will help prevent aspiration. Again, the temporary palate made by the dentist is also important in overcoming the nutritional problem. It should not be forgotten that this palate should be replaced every 1.5-2 months in parallel with the development of the baby until palate surgery.
Babies born with cleft lip or cleft palate need the skills of many medical disciplines to correct the problems caused by the existing cleft. In addition to a plastic surgery intervention to close the clefts, it should be kept in mind that as these children continue to grow, they may have disorders in their nutrition, dental health, hearing, speech and psychological development. Therefore, the cleft, led by a plastic surgeon, consists of a pediatrician specializing in cleft problems, an orthodontist who will solve dental problems, a speech and language specialist, a social worker, an otolaryngologist specializing in hearing, a psychiatrist, a nurse, and a geneticist. Consulting the lip-palate team will be the best way to choose.
One of the most important issues is the timing of the surgeries to be performed. Lip surgery should be performed within the first 3 months after the child is born. The sooner the operation is performed in these first 3 months, as long as the general health condition of the baby allows, the better (if the birth jaundice has passed, it can be done on the 10th day). In order to perform palate surgery, some development of the palate should be expected. The ideal time is 10-12. For months, before starting to speak, palate surgery must be performed at the latest at the age of 18 months. The thing to remember is that a baby born with a cleft lip and cleft palate can have a more beautiful appearance, after the first lip and palate surgeries, in a period of up to 18 years. may need corrective surgery.
The result after cleft lip-palate repair surgery, which is performed by an experienced aesthetic and plastic surgeon in cleft lip-palate repair, is generally positive and completely changes the appearance. On the other hand, as with any surgical operation, it should not be ignored that there may be problems related to surgery and some complications specific to this type of operation may occur.
The most common problem in cleft lip repair is the asymmetry problem that occurs because one side of the mouth and nose is not the same as the other side. The aim of cleft lip surgery is to close the cleft completely in the first operation, but a second or even a third operation may be required to remove the asymmetry.
The purpose of cleft palate surgery is to close the opening in the roof of the mouth, that is, in the palate, and to ensure that the child can eat and speak properly. In some cases, a second operation may be required due to healing problems in the palate or speech disorder.
