Introduction
Conventional methods of managing cleft lip and palate have successfully treated many children worldwide. However, surgical intervention is the most common way to manage cleft lip and palate. The patient has to undergo not just one but a series of surgeries to correct the faults, which usually takes a toll on the patient, especially when it is a child. To improve this aspect, researchers are constantly in search of better options that would address this issue. Taping in the presurgical phase of treatment has shown promising results in reducing the need for surgical treatment or its frequency.
What Is Pre-surgical Taping in Cleft Lip and Palate Repair?
Taping is a type of preoperative orthopedic manipulation (manual physical therapy to improve performance or enhance results before surgery) used to treat cleft lip and palate. It is a widely used tissue approximation method, which means that tissues are manipulated to come closer to each other, thereby non-surgically correcting some extent of the defect.
It involves using adhesive tape across the area to manipulate the tissues into position. Maximum tissue approximation leads to fewer technical demands on the surgery. An additional device may be assigned in cases with a particularly wide cleft to ensure the maximum outcome, like presurgical molding.
Some evidence suggests that presurgical taping has a long-term effect on development. Despite these data, taping continues to be a widely used presurgical manipulation method in correcting cleft lips and palates.
The various advantages of presurgical taping include the following:
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Ease of application
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Painless.
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Inexpensive.
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Reduces the dependency on the technical accuracy of surgery.
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Can be started at birth.
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Can be continued up to the time of surgery.
Significant changes have been noted in all measurement ranges, and researchers are looking into long-term effects on growth and development.
The indications of presurgical taping in infants include:
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If there is potential for improved feeding efficiency.
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If surgical dependency can be minimized.
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If the family is compliant with the child undergoing taping.
What Is Cleft Lip and Cleft Palate?
These are birth defects seen in newborns where there is an improper fusion of the lip or palate. Cleft lip and palate can present together or as a single defect. Cleft lip and cleft palate together are called orofacial defects.
The lip is formed between the fourth and seventh weeks of fetal development. During this time, tissues and special cells from both sides of the head come together to create the lip. Sometimes, this joining at the lip area can be incomplete, leading to a gap or slit. This slit is called a “cleft lip.” In some cases, the slit can be very narrow, but in others, it can be broad and lead up to the nose. A cleft lip can be unilateral, bilateral, or just in the middle of the lip. A cleft lip may or may not be accompanied by a cleft palate.
The palate is an organ in the mouth that is part of the oral cavity roof. It is formed between the sixth and ninth weeks of a fetus. In cases where there is an improper fusion between the tissues of the palate, a cleft palate is formed. A cleft palate can affect parts of the palate or the whole palate.
The main reasons for the development of cleft lip and palate in babies are:
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Smoking during pregnancy.
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Women with diabetes before pregnancy are at increased risk of having babies with orofacial defects.
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The use of certain medicines in pregnant women, like anti-seizure drugs (valproic acid and topiramate) and steroids, can increase the risk of developing cleft lips in babies.
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Folic acid deficiency during pregnancy.
How Are Cleft Lip and Palate Diagnosed?
While diagnosing a cleft lip during the anomaly scan in pregnancy is relatively more straightforward, diagnosing a cleft palate will have to wait until after birth. Since the defect is inside the oral cavity, it is usually not picked up by prenatal ultrasound.
What Are the Other Treatment Options for Cleft Lip and Cleft Palate?
The treatment process and timeline for orofacial clefts can be long and hectic. It takes a team of doctors from different specialties to correct orofacial clefts successfully.
The various specialists required for successful management include:
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A plastic surgeon or oral surgeon - to surgically correct insufficiencies.
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Feeding specialist - to assess and manage feeding issues related to the cleft.
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Otolaryngologist - to correct auditory or hearing issues arising from the cleft.
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Nurse coordinator - to coordinate treatment plans.
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Dentist - to address issues related to teeth and gum.
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Orthodontist - to correct position irregularities of teeth (protrusion, spacing, etc.).
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Geneticist - assesses the genetic link to any other conditions.
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Speech therapist - corrects any speech disorders related to the cleft.
The treatment for cleft lip and palate does not end with surgery. It lasts till adulthood, managing the various aspects affected by orofacial clefts. The child needs a committed care team that is critical in deciding treatment outcomes. Surgical and non-surgical care is needed to rehabilitate patients with orofacial defects successfully.
The various steps in the management of orofacial clefts are briefed as follows:
1. Prenatal Visit
Management of clefts starts before birth if it is diagnosed earlier through scans or other methods. With the increase in childbearing age, the number of cases is at an all-time high. The main purpose of prenatal visits is to help the family prepare for what is to come and keep them informed.
2. Initial Postpartum Visit
The initial postpartum visit is when the family meets the team equipped to treat their child. Then, certain imaging studies and feeding evaluations would be the first steps in management.
3. Feeding Evaluation and Management
Most children diagnosed with orofacial clefts have feeding difficulties due to their inability to suck. This issue is usually addressed by providing special bottles and training the parents on dealing with such circumstances.
4. Genetic Assessment
An orofacial (affecting both mouth and face) defect may be the presenting problem of an underlying syndrome at times. A geneticist helps rule it out and helps patients deal with future pregnancies based on their genetic variations.
5. Surgical Evaluation
In this stage, a plastic surgeon gets to assess the extent of the defect and plan treatment accordingly. Photographs for the records will be taken and stored. The surgeon decides if presurgical taping is needed for the case.
6. Presurgical Manipulation
In cases of wide clefts, presurgical manipulation is often needed to reduce the intensity and make surgery easier and more successful.
7. Surgery
The first surgery a kid with an orofacial cleft has will be lip repair. It should ideally occur between 2 and 3 months of age. Cleft palate repair should ideally happen between 6 and 12 months after the baby is born.
8. Speech Assessment and Management
The initial speech evaluation is completed between 12 and 14 months of age.
9. Revisions
The aesthetic aspect of treatment is first considered at a kid's school-going age when revisions are done to correct deformities. These revisions can continue until the child is in their early teens.
10. Orthodontics and Correcting Dental Issues
Dental and bone-related issues are corrected at a very young age.
Conclusion
Children with cleft lip and palate can lead a normal and healthy life with proper, timely intervention. The hard work of a strong team of doctors lies behind the success of each case. Parents should also be educated on dealing with such children so that both the parent's and the child's lives are made easier and happier.
