CLEFT LIP AND CLEFT PALATE
Dr. Vivek M. Rege
Pediatric Surgeon & Pediatric Urologist
B J Wadia Hospital For Children, Hurkisondas Hospital, Wockhardt Hospital, Mumbai
This is a well known and a very obvious deformity that is detected at birth. The cause of this defect is abnormal embryology. In these conditions the right half of the face and the left half of the face do not meet in the midline as they should, this leaves a gap or a cleft. In case of the lip there are 2 types of clefts - unilateral or on one side only right or left; or bilateral that is both side lips have a gap. This defect may be also associated with a cleft of the palate in a few cases.
|Both side Cleft lip
||Cleft lip & Palate
In children with a cleft palate only, there are 3 types, but here there may be cleft of the anterior or the hard palate, or cleft of the posterior or soft palate or both.
Cleft of the palate only – lip intact
Problems: In case of cleft lip there is only the facial deformity, the child is able to take oral breast feeds without much difficulty, grows well and has adequate nutrition. However, in children with cleft palate, the child is unable to suck well on the breast or the bottle and the milk given orally may accidentally enter the air passage instead of the food passage. This occurs since the palate is missing, the tongue cannot hit the palate and block the air passage when swallowing. Flooding of the air passage with milk will cause aspiration and may be life threatening to a newborn. In these children, it is best to avoid breast feeds, instead the newborns are fed with a bottle and a long nipple, alternatively, the child is fed by a long spoon or a special container called Bondla that has a long beak to allow the milk to go directly at the back of the oral cavity and swallowing is easier. The feeding is initially done by a trained nurse, who in turn will teach the technique to the mother so that the child can be sent home from the hospital and fed at home. In some children, even this may be difficult and dangerous, here we pass a tube from the oral cavity into the stomach and the feeds are given by a syringe directly into the stomach, by passing the oral cavity. These feeds are given by gravity and never to be forced by the piston of the syringe. The feeds are essential for the nutrition and weight gain in the child. These children are very prone to getting recurrent attacks of respiratory infections due to minimal aspirations of feeds into the air passage and thence to the lungs. Untreated or uncared for babies with cleft palates often are brought to us for failure to gain to weight, poor nutrition, and recurrent infections.
Surgery: In children with cleft of the lips, correction of the deformity is done at the age of 3 – 6 months. The repair is a very fine delicate surgery to bring the halves together with precise, fine sutures to give an almost invisible scar later in life. The child is kept in the hospital for a few days, feeds are begun the next day with plastic spoons to avaoid any injury to the freshly sutured lip. Healing is usually excellent. In children with cleft of the palates, surgery is done later since this is a very major surgery and there may be considerable blood loss during the surgery. The ideal age of surgery in these cases is about 1 ½ years and the child remains in the hospital for a few days and is then sent home on a regular diet. The two halves of the palate are brought in the midline together with 2 or 3 layers of tough sutures so that they do not break apart.
Complications: In these surgeries, the most common is either infection or disruption of the sutures. In case of the dormer, higher antibiotics are necessary, and in the latter, the repair is done again after a period of 6 months to allow the local tissues to heal before a fresh attempt to close the gap is one.
Last Updated: 27th January 2009