Dr. Sanjay Wadhwa

Cleft lip and cleft palate are the two most common birth defects affecting children all over the world. What happens in the cleft lip is that the upper lip is incompletely formed and in cleft palate abnormalities, we see babies with an incompletely formed roof of the mouth. Both these can be found individually or can occur together. These conditions can be severe or mild and affect one or both sides of the face.

Causes
The fEtus undergoes the separation of the upper lip and the roof of the mouth pretty early. In certain cases, this separation does not happen or happens incompletely and certain parts of the upper lip and roof of the mouth fail to form properly leading to cleft lip and palate.

Repair through surgery

1. Plastic surgery is the only way to repair a cleft lip and/or palate. Both of these impair vital functions like speaking, eating, breathing, and hearing properly.
2. Surgery is done to restore function and to make the affected child look more normal.
3. Most cleft lip and palate surgeries are done on very young children usually 3 months to a year old.
4. Before the actual surgery, a team of specialist define a course of treatment, including repair of the cleft using surgery, which means plugging the hole in the lip or the palate; speech rehabilitation and dental restoration, as the child usually has no teeth in the affected parts of the upper palate.

The specialists required are:

1. Plastic surgeon
2. Pediatric dentist
3. Ear, nose, and throat specialist
4. Auditory or hearing specialist

What happens during surgery?
Usually, cleft lip surgery happens in children as young as 3-6 months old. It has to be carried out under general anaesthesia. If the condition is severe, and the cleft lip is wide, special procedures like lip adhesion or a moulding plate are used to bring the two parts of the lip closer and it is fully repaired.

Cleft palate repair surgery is done at the age of 9-12 months only.
What happens here is that plastic surgeons bring together the muscles of the upper soft palate and rearrange them to cover the gaping hole in the roof of the mouth. The surgery is usually done under general anaesthesia and requires a short hospital stay.

• Without a normal palate, the child can’t speak properly. So, surgery helps to improve and normalise speech.
• And that’s not all. The child may require more surgeries as he grows older to treat these two problems.
• This is because the child’s facial structure changes and he or she may require advanced surgeries like pharyngoplasty, which helps improve speech, or alveolar bone grafts to provide stability for permanent teeth.
• A bone graft is usually done when the child is 6-10 years old and it closes gaps in the bone or gums near the front teeth. If you wish to discuss about any specific problem, you can consult a pediatrician.