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.