Cleft lip and palate (cleft surgery)

Cleft lip and palate, whether individual or combined, represent one of the most common congenital defects of the head and neck.

A cleft can involve the under-nose area and lip on one or both sides, extending through the alveolar ridge, hard palate, and the entire soft palate. Depending on the affected structures, they are referred to as complete and incomplete clefts.

A common accompanying deformity in patients with cleft lip and palate is a disorder of the soft tissues and cartilage of the nasal wing and nasal dome. Infants with a cleft face feeding problems as breastfeeding is often hindered.

CLEFT LIP AND PALATE – MOST COMMON COMPLICATIONS

Complications arising from these deformities or their surgical treatment that occur in the majority of cases include:

WHEN IS CLEFT LIP AND PALATE TREATMENT POSSIBLE?

Primary treatment of cleft lip and palate is carried out between 3 and 18 months of the newborn’s life, depending on whether the lip, palate, or both are being operated on.

CLEFT LIP AND PALATE – PRE-OPERATIVE PREPARATIONS

Several procedures are often necessary to achieve satisfactory results. The optimal age for closing the cleft lip is between 3 to 6 months of age, and for the cleft palate, around 18 months, ideally before the child begins to speak.

A multidisciplinary approach is essential for addressing cleft lip and palate, so the team of doctors must include a dentist-orthodontist who will continue the patient’s treatment after surgical intervention.

Pre-operative preparation includes pediatric examination, laboratory tests, and nasal and oral swab checks.

SURGERY

The operation for cleft lip and palate lasts about two hours and is performed under general endotracheal anesthesia.

During the closure of the lip, the edges of the cleft are refreshed, and the surrounding tissue is immobilized. Reconstruction of the nostril floor is performed, followed by shaping the lip.

In the case of a bilateral cleft, one side is operated on first, and after three months, the other side is addressed.

The surgical closure of the palate ensures normal speech. After refreshing the edges of the cleft, layers are formed that separate the oral cavity from the nasal cavity. The soft palate is moved backward toward the throat, and the stitches are resorbable.

Nasal and facial deformities are corrected after the complete growth of the bones and cartilages is achieved.

POSTOPERATIVE RECOVERY

After the cleft lip and palate surgery, it is crucial for the child to take plenty of fluids in the first days and later to consume soft food. Stitches from the lip are removed on the seventh day.

If there are speech difficulties, speech therapy should be conducted in preschool age. The development of teeth should be monitored by an orthodontist.

CLEFT LIP AND PALATE AND OTHER SURGICAL PROCEDURES

After cleft lip and palate surgery, the majority of patients may require additional surgical interventions. These include alveoloplasty and repair of the oro-nasal fistula.

ALVEOLOPLASTY

Almost routinely, at the age of 6 to 9 years, a procedure is performed where the cavity of the alveolar ridge (the area where the cleft palate was) is filled with a bone graft taken from the chin or thigh, and the oro-nasal fistula is closed. This creates conditions for the upper canine tooth to grow through the graft, making the upper jaw a whole.

REPAIR OF THE ORO-NASAL FISTULA

The consequence of an oro-nasal fistula is the passage of food liquids from the mouth into the nasal cavity, which is often unpleasant for the patient.

Depending on the patient’s age, the intervention can be performed under local or general anesthesia. The defect is closed in two layers – nasal and oral – using local flaps, and in rarer cases, distant flaps (lingual, pericranial, etc.).

Revision of scars and deformities of the nasal wing and septum are addressed within the scope of aesthetic (plastic) facial surgery. Maxillary retrognathism, as a result of cleft surgery, is resolved within orthognathic surgery.