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Cleft Lip and Palate Repair

Cleft lip known as Cheiloschisis is the incomplete formation of the upper lip. Cleft lip happens when the tissues on the lip and gum do not join and forms a gap. It can occur as a one sided (unilateral) where there is a gap above the upper lip and below a nostril or two sided (bilateral) where two gaps above the upper lip and below the nostrils. It may also be a partial or incomplete cleft lip where gap is small or if the split extends from the upper lip and goes all the way to the base of the nose it is considered a complete cleft lip.

Cleft palate known as Palatoschisis – is incomplete formation on roof of the mouth. It happens as a split or opening in the roof of the mouth. The failure involving the hard palate and/ or the soft palate to join up, leaving a gap in the roof of mouth. A cleft palate may vary in severity and size. It can be a defect only on the soft palate to a complete cleft that extends through the hard palate.

 As the lip and palate develops separately, it is possible to have the following cleft condition:

  • Cleft lip without a cleft palate
  • Cleft palate without a cleft lip
  • Cleft lip and cleft palate together

The cause of a cleft lip and palate is unknown. However, sometimes it's genetic and runs in families. Other contributing factors such as a prenatal use of certain medications, exposure to cigarette smoke, or lack of certain vitamins during pregnancy may predispose to having a cleft lip and palate baby.

 Cleft lip and palate can be associated with other problems, including

  • Feeding difficulties due to a separation or opening in the palate, liquids and food can pass from the mouth back through the nose
  • Increased risk of ear infections. If left untreated, ear infections can cause hearing loss.
  • Speech problems because the palate that normally separates the nose from the mouth for most sounds does not close adequately. This condition makes it sound as if the person is talking through the nose.
  • Dental abnormalities and teeth problems may require dental and orthodontic treatments.

What does the surgery involve?

Cleft lip and cleft palate repair is surgery performed by plastic surgeon who fix and correct abnormal development or malformation of the cleft lip and palate. The goals are to restore normal function; improve ability to drink, eat, speak, hear and breathe; reconstruct to achieve a more normal appearance with minimal scarring.

The timing of the cleft repairs depends on the individual circumstances of the child. Surgery to close and repair a cleft lip usually performed when a child is three to six months old. An operation to repair a cleft palate usually happens a bit later - before the age of one year. The types of surgery the child needs will depend on how severe the cleft is. In most cases, a series of surgeries may be required.

Discussion during Consultation

Dr Fok will assess the condition and do a complete physical examination on the child before discussing with the child’s parents about to the timing and nature of surgery required. The decision to have cleft surgery is extremely personal. Dr Fok will explain in details the benefits, goals and potential risks or complications associated with surgery.

What happens on the day of surgery?
 
Repair of cleft lip and palate surgery is done in the hospital with about two to three days stay. The child will undergo general anaesthesia and be taken care by an anaesthesiologst while Dr Fok performs the surgery. The operation takes about two to three hours.
 
What to expect during the recovery phase?
 
The surgery wound should be kept clean and antibiotic ointment to apply on the wound will be prescribed by Dr Fok to aid in healing and prevent infection. Instruction on feeding the child and any specific activity instructions will be provided. The child’s discomfort can be controlled with pain medication. Sutures will be removed five to seven days following surgery. Healing will continue for several weeks as swelling resolves.
 
What are the risks?
 
Complications are infrequent and most cases usually do well post operatively without any complications. However, the risks and complications that can happen includes
  • Bleeding (hematoma)
  • Infection
  • Poor healing of wounds
  • Irregular healing of scars including contracture (puckering or pulling together of tissues)
  • Residual irregularities and asymmetries
  • Anaesthesia risks

The cosmetic result often depends on the severity of the deformity. Secondary procedures may be needed for functional reasons – to improve speech, breathing and dental occlusion or to refine appearance such as to revision of scar.