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| Cleft Lip and Palate Repair |
A cleft lip is an incomplete upper lip formation present at birth that appears as a separation on one or both sides.
An incomplete formation of either the hard or soft parts of the upper palate inside the mouth is a cleft palate, also present at birth. These defects may cause impaired feeding, speech, dental development and hearing, and will require surgical treatment by a team of specialists.
Cleft lip repairs are initially performed when a child is at least 10 weeks of age and 10 pounds in weight and has a hemoglobin (or blood count) of at least 10.
Cleft palate repairs are generally performed when a child is somewhat older, from 9 to 18 months of age.
Correction of a cleft lip or palate usually requires multiple procedures during a child's growth and development. Intervention is recommended early because of other medical problems that can be associated with clefting, particularly ear infections.
MANAGEMENT OF CLEFT LIP AND CLEFT PALATE PATIENTS Both above defects are surgically correctable problems. Child becomes as good as normal after full course of treatment.
CLEFT LIP-Unilateral and Bilateral----Surgery is done at three Months and above. If surgery not had done in child hood it can be done at any age.
Prerequisite for surgery
Age 3monhts and above
Weight of child ---4.5 kg and above.
Haemoglobin---- more then ten gmChild should be in GOOD HEALTH STATE and FREE FROM ANY INFECTION.
Pre operative investigation-----CBC, ( Hb.TLC,DLC, ESR,), BT,CT
Pre operative consultation from Paediatrician for fitness of surgery.
SURGERY---Child is admitted one day before, antibiotics are given and under standard general anaesthesia repair of cleft lip is done. I do modified Mellard's rotation advancement flap. Feeding is started on same day six hrs after surgery. Usually child is discharge on next day if every thing is Ok. Suture removal is done after six days of surgery. No specific care is required after surgery. Parents should take care that child should not get injured or fall from bed. CLEFT PALATE---Defect in palate can be unilateral, bilateral or partial and only bifid uvula may be present.
Timing of surgery---Nine months to eighteen months.
Preoperative investigations.Hb,TLC, DLC, ESR, and BT, CT. Pre operative paediatric consultation. Weight should be more then nine kg and child should be free from any active infection.
Surgery---Child is admitted one day before surgery, preoperative antibiotics are given. Child is operated under standard general anaesthesia. Standard palatoplasty is done using vicry suture. Child is kept nil orally for six hrs after surgery and then given clear fluid in full awake state very slowly .Patient is discharged after one or two days after surgery. There is no need to remove sutures.
FEEDING OF CHILD WITH CLEFT--- spoon feeding is better then bottle feeding. Multiple small feeds at short intervals should be given. During feeding child head (upper body part) should be kept above ( 45 degree angle ), and after feed allow him to do ----Dakar. After feeding put child in lateral position rather then supine. We should take all precaution that child should not aspirate.
Above two surgeries are basic surgeries for these patients.Child may need other surgeries to correct secondary deformities, and surgery for correction of speech is needed. Speech therapy, orthodontic treatment, rhinoplasty may be needed. These surgeries I will be covering further bulletin.
CASE I
CASE II
CASE III & IV
CASE V
Cleft lip repairs are initially performed when a child is at least 10 weeks of age and 10 pounds in weight and has a haemoglobin (or blood count) of at least 10.
Cleft palate repairs are generally performed when a child is somewhat older, from 9 to 18 months of age.
Correction of a cleft lip or palate usually requires multiple procedures during a child's growth and development. Intervention is recommended early because of other medical problems that can be associated with clefting, particularly ear infections.
FREE SURGERY FOR CLEFT LIP AND CLEFT PALATE DR.Anil garg is operating patients of cleft lip and palate free of cost those who can not afford. He is associated with SMILE TRAIN organisation which is US based organisation working for these patients. You can e mail your quarry to Dr.Garg.
SECONDARY DEFORMITIES OF CLEFT LIP AND PALATE CLEFT LIP AND PALATE PART II Secondary problems in patients of CLP
After repair of cleft lip and palate these patients needs attention for following problems.
CLEFT LIP SECONDARY DEFORMITIES
 Lip scar, whistle deformity means defect of vermillion. Cleft lip nasal deformities, flaired alae, deviated nasal septum, columella deformities.
Alveolar defect, deformed teeth etc. Above all defects needs attention and correction at different stages.
Clip scar and vermilion deformities can be corrected at earlier stage.
Cleft lip nose deformities can be corrected at later age, may be after 15 yrs of age.Some prefer to do it at much earlier age.
Alveolar bone grafting, orthodonatic correction can be done after eight years of life.
Fistula closure can be done after two years and pharyngoplasty after three years of age.
Patients of cleft palate may need speech therapy also.
This patient had bilateral cleft lip and palate. Large defect of vermilion,
Anterior palatal fistula, vellopharyngeal incompetence. All defects were treated in one stage. To correct vermilion defect, bilateral vermilion advancement flap was used.
This patient had vermillion defect i.e.whistle deformity Post operative pictures shows complete correction. I use vermilion advancement flap to correct defects.
This boy had severe cleft lip nasal deformity. Septoplasty, collumelar strut, reconstruction of alae by conchal graft, and nasal tip augmentation with conchal graft done.
Pharyngoplasty, closure of palatal fistula and other secondary corrections in patients of cleft lip and palate will be discussed in further bulletins.
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