Introduction
Cleft lip and palate are deformities seen in the child since birth. These occur due to developmental defects. The reason for their occurrence is the improper formation of the baby’s lip or mouth during development. It can be corrected with a surgical procedure. This article briefly highlights the causes, symptoms, and correction of cleft lip and palate.
What Is Cleft Lip?
During the developmental stages of the pregnancy, lips are formed in the fourth to seventh weeks of the gestation period. As further development occurs, the body's tissues and the fetus's head start growing from both sides towards the center, thus completing the facial formation. When the joining of all the tissues takes place, the formation of different facial features takes place like the lips, mouth, etc. During this formation, if the tissue responsible for forming the lip does not join completely before birth, it is said to be a condition called cleft lip. An opening in the upper lip is left as a result of this. This opening can be tiny or large, extending up to the nose. A cleft lip can be seen either on one or both sides of the lip or in the middle of the lip, which is seen too rarely. Children who have a cleft lip also can possess a cleft palate.
How Is Cleft Lip Corrected?
Cleft lips cause multiple problems in the child at the time of feeding. The baby may not be able to suck milk properly from the breast of the mother. In later stages of life too, they may face dental problems, speech problems, and even issues with self-esteem and social interactions. The surgical repair fixes the split (cleft) in the child’s lip. This surgery is done normally when a child is three to six months old. It has the following steps:
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The child is anesthetized.
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The surgeon places an incision (cut) along the edges of the cleft lip that extends up into the nose.
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Stitches are placed to reapproximate the muscle of the child's upper lip.
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Cut edges of the skin are brought together to shape the upper lip and nostrils.
What Is Cleft Palate?
The roof of the mouth or palate’s formation occurs between the sixth and ninth weeks of pregnancy. A cleft palate occurs if the tissues responsible for forming the roof of the mouth do not join completely before birth. In some babies, the front and back parts of the palate are open; in others, only part of the palate is open. A cleft palate results in various problems, like making it hard for children to eat and speak. Food and liquids become hard to consume. The food items go up by the opening into the nose (nasal passage) instead of moving down into the throat and to the stomach.
How Is Cleft Palate Corrected?
The cleft palate is one of the commonly occurring deformities in newborn babies. Every year around 1 in 600 babies are born with a cleft. The definitive cause is unknown, but studies are going on to understand the condition further and highlight that genetics (conditions that run in families) and the environment matter. One needs to meet a healthcare provider specializing in genetics to rule out more about what might have caused a cleft palate in a child. The only way to correct a cleft palate is through surgery. Cleft palate surgery is done when a child is around 12 months old. Depending on the child they may require two surgeries also. The aim is to close the opening in the roof of the child’s mouth. The child will be in the surgery room for two to three hours. The hospitalization is generally of one to three days.
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The child is anesthetized.
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A device is placed into the mouth of the child to keep it open during the surgery.
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Incisions (cuts) are placed on both palate sides along the cleft.
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The layer of tissue attached to the bone of the hard palate is loosened. This allows the tissue to get stretched.
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A cut along the gums is placed. This allows the tissue of the palate to be stretched and moved toward the center of the roof of the mouth. The incisions alongside the gums are left open to heal for the coming three weeks.
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The inner (nasal) layer of tissue using stitches (sutures) is closed so that it will dissolve as the incision heals.
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The outer (oral) layer of tissue is closed with sutures that get dissolved.
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The incision inside the child’s mouth resembles a ‘Z’ pattern.
What to Expect Beyond Physical Correction?
In the case of cleft lip surgery:
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Two to three weeks are required for healing completely. After the cleft lip repair, care must be taken not to bump into the child’s lip. The area is very fragile initially until healed.
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After cleft lip surgery, stitches are placed in the child’s lip and nose.
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The area around the stitches turns pink and slightly swollen.
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Care for the suture line on the lip and nose, as demonstrated by the nurses in the ward, should be provided.
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The child might be slightly unsettled for one to three weeks after a cleft lip repair and need extra attention.
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Paracetamol and analgesics are required for pain relief, frequently only for a few days.
In the case of cleft palate surgery for the first few days after surgery, the following things are noticed:
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A small amount of blood may be in the mucous or saliva (spit) for several days.
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The mucous or saliva may appear pink.
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More clear drainage (mucous) may come from the nose for several weeks.
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Pain relief medications might be advised for some days.
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The problems the child faces are restricted, especially in the upcoming years of life.
Conclusion:
Cleft lip and palate are both deformities at birth. These occur in the developmental stages of the pregnancy. A surgical process can correct these. This eradicates various problems faced by the child, like sucking milk, speaking, etc in case of a cleft lip. In the case of cleft palate, this repair helps with difficulty in swallowing, speaking, etc. aesthetics concerns are also solved by this repair.
