Harelip, orofacial clefts
Cleft lip and palate, collectively known as “orofacial cleft”, is a type of birth defect that occurs due to malformation of a baby’s lip or mouth during pregnancy. The lips and palate usually form in a baby between the fourth to seventh weeks and sixth to ninth weeks of pregnancy respectively. Clefting is found to occur when the tissues responsible for the formation of mouth or lip are not sufficient enough and they fail to join together properly.
A cleft lip is characterised by an opening in the upper lip which may extend into the nose. The cleft may be present on one side of the mouth (i.e. unilateral clefting) or on both sides of the mouth (i.e. bilateral clefting). On the other hand, a cleft palate occurs when the roof of the mouth contains an opening that extends into the nose. A cleft palate may either affect the soft palate or may even extend into the hard palate. Cleft lip and cleft palate may either occur individually or together.
The cause of cleft lip or cleft palate is not always known. However, doctors believe that such a condition arises due to a combination of genetic and/or various environmental factors. Both mothers and fathers can carry and contribute the genes responsible for the formation of cleft lip or cleft palate in their baby. However, intake of certain medicines (for example, anti-seizure medications), lack of proper prenatal nutrition (such as folic acid), exposure to certain chemicals, smoking cigarettes, using drugs or drinking alcohol during pregnancy, may increase the chance of their baby to acquire such defects.
Cleft lip and palate may give rise to other issues related to mouth and face. Some of these problems include feeding problem, loss of hearing or other problems related to ear, dental problems and speech issues. Cleft lip and palate and other associated problems can be cured by surgical methods.
Cleft lip and palate, an inherited birth defect, may give rise to other problems related to feeding, hearing, teeth and speech. Such problems can be corrected by surgical methods within the first twelve months after birth. Cleft lip with or without cleft palate can be diagnosed during routine ultrasonography of a pregnant woman. However, certain cases of cleft palate (such as submucous cleft palate and bifid uvula) may remain undetected until later in life.
A cleft lip is generally corrected by surgical methods in the hospital using general anaesthesia when the child is 3 to 6 months in age. In case, if the child has a wide cleft lip, then special procedures such as lip adhesion or a moulding plate device may prove helpful in bringing the parts of the lip together prior to the surgery. Such surgical procedures may leave some scars on the lip under the nose.
A cleft palate is usually repaired at the age of 9 to 12 months. This surgical treatment is performed by the plastic surgeons, who connect the muscles of the soft palate and rearrange the tissues near the cleft. This surgical method needs general anaesthesia and hospital stay for a short period of time. The aim of this surgical procedure is to create a palate that will help in speech. However, a few children continue to sound nasal even after the repair of cleft palate.
Further surgeries may be required in future as the child grows older in order to adjust with the facial structural changes. These include pharyngoplasty and/or alveolar bone grafting. As the child grows older, he/she may feel the need to make their scars less noticeable, improving the appearance of his/her lip or nose, or improve their bite with the help of orthognathic surgery. Such surgical treatments help to improve breathing and speech.
Children who are born with defects like cleft lip and cleft palate (or both) are eligible for this treatment in order to correct other related problems like speech, hearing, feeding, breathing and other dental issues. However, such surgical treatments in order to repair this condition work best when the child is between three to twelve months old.
Children who are normal and are born without a cleft lip or cleft palate are not eligible for this treatment. Moreover, children who are below three months in age and are having cleft lip and palate are also not eligible for this treatment. Such surgical methods of treatment are given to the affected children only when they are older than three months in age.
Most of the side effects for surgical treatment of cleft lip and palate are quite normal and do not pose serious threat to the children who have undergone this treatment. Such side effects include post-surgical irritation of the operated area, mild pain (which can be reduced by medications, as directed by the physician), bruises, swelling and slight oozing of blood from the operated area.
However, a few children are seen to suffer from serious side effects after they are surgically treated in order to correct this condition. These include coming out of stitches resulting in opening up of the incision, profuse bleeding, infection of the operated area, high fever, breathing problems and/or inability to drink liquids. It is recommended that you call your doctor immediately if your child suffers from any of these serious post-operative side effects.
For a period of 3 weeks after the surgery, the cleft lip and palate repair may not be strong enough to resist the damage that may be caused by other objects or even fingers. Hence, proper care and the child’s comfort should be given the first priority, in order to prevent any kind of injury and promote healing. The post treatment guidelines for the children who have undergone such surgical treatment includes feeding liquid or other soft food items like milk, juices, well melted ice-cream, slightly warm broth, gelatins, smooth yogurt, puddings, custard, softened cereals, etc. Care should be taken, not to feed such children with bottles or pacifiers. A small cup or the end of a spoon may be used to drop the fluids into the child’s mouth.
The children who have undergone this treatment should wear arm restraints for a period of at least 10 days in order to prevent hurting themselves with their fingers. In case, the child faces from any serious post-operative side effects then his/her parents must immediately call a doctor in order to solve the problem.
The problems of cleft lip and cleft palate may be cured by surgical treatments. General anaesthesia may be required in order to complete this surgery and there are some important rules that need to be followed regarding eating and drinking, in the hours prior to the surgery. It generally takes about 2 to 6 hours to complete the surgical procedure, based on the type of cleft lip and palate repair that the child needs. An overnight stay of 1 day in the hospital is recommended for such children who have undergone the surgery. After the child is discharged, it takes about three months for him/her to completely recover from the condition.
The price of treatment for cleft lip and palate varies in different parts of India and is seen to be much lower in comparison to the price of treatment in other countries. However, the price of treatment depends upon the type of surgery involved in correcting the condition of cleft lip and palate. On an average, the cost of this surgical treatment ranges from Rs. 1,36,620 to Rs. 2,01,670 in India. This treatment is available in all major cities in India.
The surgical treatment for correction of cleft lip and palate is permanent and is considered to be the best way to repair such birth defects. However, at times later cosmetic surgeries may be required in order to adjust with the facial structural changes when the child grows old. These include pharyngoplasty, orthognathic surgery and/or alveolar bone grafting.
Rs. 1,36,620 – Rs. 2,01,670
A cleft palate and cleft lip are among the most common congenital birth defects. These conditions can occur individually or together and vary in severity and the side of the face affected. A cleft palate not only mars the beauty of a child, but can also lead to serious health problems associated with speech and food intake.
A cleft palate can be diagnosed in the 17th week of pregnancy with the help of an ultrasound. This condition develops when components of the upper lip and ceiling of the mouth fail to develop normally. A cleft palate can affect children of all races equally but an isolated cleft palate is more common amongst female babies than male babies.
In most cases, a cleft palate can be surgically reconstructed within the first year of a baby’s birth. This not only improves the child’s appearance, but also improves his or her ability to breath, eat, speak and hear. A cleft palate reconstruction surgery is performed under anaesthesia. To begin reconstructing the ceiling of the mouth, incisions are made on either side of the cleft. A specialised flap technique is used to reposition muscles and tissues in the palate so as to bridge the gap. This is then stitched close with removable or absorbable sutures.
Dressings or bandages may be placed over the sutures after surgery. It is essential to prevent your child from sucking his or her thumb or putting anything in the mouth that could hamper recovery. Pain medication may also be prescribed to help your child deal with the discomfort. Over the following few weeks, the swelling will subside and incisions will heal. It is also important to protect your child from sun exposure at this time to prevent the formation of jagged scars.
While a single surgery is often enough to repair a cleft palate, treatment for the same may continue into adolescence. Sometimes this can also extend into adulthood. In some cases, further plastic surgery may be required as the child grows to improve appearances and functioning of the palate. If you wish to discuss about any specific problem, you can consult a Cosmetic/Plastic Surgeon.
Cleft palate or palatoschisis is a common genetic abnormality that leads to a horde of problems and is presently a growing challenge to medicine practitioners. The major developmental stages affected due to this particular irregularity include feeding, speech development, dentition and maxillofacial growth which are rather important to the normal overall developmental pace of an individual. Even though the cleft palate deformity was defined centuries ago, no fixed management algorithm exists for patients suffering from the condition in the present day scenario.
Cleft palate may be successfully fixed using reconstructive surgery. Multiple specialists are involved in the reconstruction surgery including plastic surgeons, otolaryngologists, nutritionists, oromaxillofacial surgeons and speech pathologists. Some hospitals also consider psychological therapy for the patient and the family to help get through the emotional trauma and the issues faced due to developmental backlogs.
The treatment for cleft palate usually begins around 9 to 12 months of age. If left untreated, it may cause major deformities. It takes about some years before the whole procedure is completed although it depends on the type and severity of the deformity.
The process involves the administration of anaesthesia after which the palate repair closes the inner, middle and final layers and at the same time realigning of the palatal muscles in a technique called anintravelarveloplasty is conducted. This ensures that the muscles are adjusted in a normal position which facilitates the best functioning of the palate during feeding, swallowing and speaking. It is possible that the child might require more than one surgery to completely close the palate.
Cleft lip and palate repair surgery is a surgical procedure, which is used to fix problems of the upper lip and palate. A cleft may be a small patch on the lip or a complete furrow that extends all the way to the lower part of the nose. A child usually has one or both of these conditions at birth. This is a serious birth defect and can only be corrected with specialized plastic surgery techniques.
Why it is needed?
Cleft lip and palate surgery is necessary to correct abnormal development of upper lip in a child and to restore a normal appearance and function. The surgery can improve the child's ability to speak, hear and eat. In most cases, lip is operated at 3-4 month of age, so as to allow the palate to change along with the growth of the baby. The child in kept in the hospital for 2-3 days.
Steps to be taken before the procedure
A therapist needs to be consulted before the surgery, as the therapist would analyze the best way to feed the child before surgery. The child must gain weight and has to be healthy before the surgery is performed. The health provider may do some blood tests and carry out a complete physical examination of the child. About 10 days prior to the surgery, it is necessary to stop giving the child aspirin, ibuprofen, warfarin and any other drug that inhibits the clotting of blood.
Post surgical care tips
The child will be kept in the hospital for 5 to 7 days after surgery and complete recovery may require up to 4 weeks. The following tips need to be followed for quicker recovery: