The Journey of Cleft Lip and Palate Surgery: From Diagnosis to Recovery

Amongst the most frequently seen congenital defects of the face are the cleft lip and cleft palate, which occur in one in 700 children born worldwide. Alongside a potential impact on a child's aesthetics, this condition might lead to feeding and speech difficulties or hearing if it is not treated. Fortunately, cleft lip and palate can be addressed through surgery so that suffering children may enjoy apparently normal lives.

What Is A Cleft Lip And Palate?

Cleft lip and cleft palate occur when a baby’s facial structures do not fuse properly during pregnancy. They can occur together or independently.

• Cleft Lip: This is a congenital defect where an opening or gap exists in the upper lip. It can appear in almost any shape, such as a small notch to a large gap that reaches toward the nose. A cleft lip can be unilateral or bilateral.
• Cleft Palate: In the cleft palate, the roof of the mouth, which is called the palate, does not close. An opening is left behind and this sometimes impacts the hard palate as well as the soft palate. It can occur in isolation or with a cleft lip.

Causes of cleft lip and palate

The causes of cleft lip and palate are not yet clear, but is attributed to a complex interaction of genetic and environmental factors.

• Genetics: A high chance of transmission from one generation to the next. The parents may pass it down if they have a family history of having cleft lips or palate.
• Environmental Factors: It is said that environmental factors-like smoking, heavy alcohol consumption, and low intake of folic acid-are a predisposing factor for these conditions, associated with early gestation.
• Medications: Some drugs used for pregnancy may expose them to this disease, most often as a cause of epilepsy.

Diagnosis of Cleft Lip and Palate

Cleft lip and palate are mostly diagnosed either during pregnancy or a few days after birth.

• Prenatal Ultrasound: Most cases are diagnosed during routine prenatal ultrasound. It is usually diagnosed during the 20th week of gestation. Ultrasound can detect cleft lip, but not cleft palate, prior to birth.
• Physical Examination: If the condition has not been diagnosed before a baby's birth, it would probably be diagnosed with the physical examination of a newborn. A cleft lip is quite palpable, while the inside of the mouth can tell if there is a cleft palate.

Why is early intervention important?

An early diagnosis allows for the planning of proper treatment. A multidisciplinary team, consisting of a plastic surgeon, paediatrician, speech therapist, and orthodontist, can be involved to collaborate with the family in tailoring an individualised treatment plan. Early intervention to work through feeding difficulties, speech development, and social integration as the child grows is important.

Surgical treatment of cleft lip and palate

The primary treatment for cleft lip and palate is surgical correction. The extent of the operation depends on the size of the cleft.

1. Cleft Lip Repair (Cheiloplasty)

Cleft lip surgery is usually done between the ages of 3 to 6 months old. It is performed to create the shape of the lip and thus a natural appearance.

2. Cleft Palate Repair or Palatoplasty

The cleft palate surgery is usually done when the infant is between 9 and 18 months of age. This is done to seal the hole in the palate to avoid speech and hearing problems as the child grows.

Postoperative Care and Follow-up

Cleft lip and palate surgery requires extensive surgical procedures for repair and thus follow-ups to ensure proper functioning and normal development.

• Feeding support: Feeding is always challenging for babies with cleft lip or palate. In the case of preoperative management, there may be a need for special bottles and feeding techniques. In most cases post-surgery, feeding improves; however, regular monitoring and advice from a paediatrician or speech therapist may be necessary.
• Speech therapy: Cleft palate surgery could heal the tissue of the mouth, but some children may still have speech problems. Speech therapy may thus be an important factor in helping children develop proper speaking skills and good communication skills.
• Hearing Tests: Children with cleft palate often develop fluid accumulation in the middle ear. These often affect their hearing and thus require regular test checkups to ensure proper hearing.
• Dental and orthodontic care: People affected with cleft lip and palate often have unique requirements for their dental and orthodontic treatment. The present patient has missing or displaced teeth; and, quite possibly, other structures of the oral cavity requiring correction as this child grows. This may be achieved through the use of orthodontic treatments including braces.
• Counselling: Psychosocial support, particularly counselling, gives the child confidence and self-esteem because he or she sees more and more of his or her peers around.
• Long-term perspective and success rates: Advances in the technology used in the medical field and surgical skills, have made most children who undergo cleft lip and palate surgery live healthy regular lives. Chances of success with these surgeries are normally high and, as one awaits most of these children, their appearance will greatly improve alongside speech as a whole aspect of life.

However, the severity of the condition may increase if treatment is delayed. Such children may require more surgeries or treatment as the child grows. Patients should follow up regularly with their medical teams to monitor development over time and to identify any challenges early.

Conclusion

In cases with cleft lip and palate surgeries, the route from diagnosis to recovery is hard, but rewarding for patients. When born with cleft lip and palate, children can get over many obstacles in life and have a full happy life if they have proper medical care and support. In fact, the success of the treatment depends on three major factors: early diagnosis, timely surgery, and post-operative care. A good supporting team of specialists is highly important, too.