Cleft lip is a birth defect that affects about 1 in every 1000 children born in India. It is characterized by a deformity in the upper lip and can vary from a small notch to a complete slit that extends all the way to the base of the nose. A cleft palate is a split in the roof of the mouth of the baby occurring at the hard palate, the bony front part of the roof of the mouth or the softer back portion. Both the conditions can occur at one or both sides of the mouth and they can also occur together.
How do Clefts Occur?
The bones and tissues that form the baby’s upper jaw, mouth and nose come together and fuse to form the upper lip and roof of the mouth during the first 6-10 weeks of pregnancy. Clefts occur when the fusion process does not happen completely. In the lips, a cleft can be on any one side or both sides of the mouth called unilateral and bilateral cleft, respectively. Most of the clefts can be put into one of the three categories:
- Cleft lip: It is more common in boys and can be unilateral or bilateral
- Cleft palate: It is more common in girls and can also be unilateral, bilateral or incomplete
- Cleft lip together with cleft palate: It is more common in boys
The cause in most cases is unknown but the general consensus is that a combination environment and genetic factors contribute to it.
How does Surgery Fix Clefts?
Due to the number of medical and oral health issues associated with clefts, a team of doctors and specialists such as a plastic surgeon, otolaryngologist, oral surgeon, orthodontist, dentist, speech-language pathologist, etc. are often involved in the treatment of these children.
The first Cleft Lip Surgery is usually performed by the time the baby is 3-6 months old under general anesthesia. Procedures such as lip adhesion or a molding plate device is used to bring the lips together in cases where the cleft is wide before the lip is fully repaired. The stitches normally used are very small to keep the scar as minimal as possible.
A cleft palate surgery is normally performed at the age of 9-12 months and followed up with multiple surgeries over a course of 18 years as the children grow and the physical structure of the face changes. The additional surgeries to improve speech such as pharyngoplasty or alveolar bone grafts to provide stability to permanent teeth are performed between the ages 6 and 10. Other procedures could also be performed to improve the appearance of the nose and lip and repair of the scars post adolescence to give them a normal appearance.
Most of the babies heal from the surgery without complications and their appearance after healing depends on how severe the defect was in the first place. Follow up procedures can give them a totally normal appearance as they get older and it need not be an expensive affair with plenty of affordable surgery packages available at multiple medical centers. Hearing and speech problems are common in children with cleft lip and palate and can be treated over time with regular therapy.