Cleft Lip Nasal Deformity

Early surgery in cleft lip-palate can prevent the child from learning wrong coding at the stage of perceiving their own voice, thus it can be easier to overcome the speech problems of the child who can code their voice properly. ⠀

If there is no problem with the development of a baby with Cleft Lip-Palate, the surgery can be performed when the baby is three months old. Furthermore, a surgery performed at the right time using the right techniques can decrease the number of surgeries depending on the degree and type of the cleft lip-palate and give great results in terms of obtaining a normal appearance until the school age. ⠀

Therefore, it is possible to minimize and prevent psychological and social issues when a child born with such anomalies can speak normally and have functioning and aesthetic nose, lips and chin.

If cleft lip-palate is not treated, babies will start to experience feeding problems. Following, they can develop acute otitis media and hearing difficulties. Later in life, the child can have speech disorders. The speech disorder will be permanent if the anomaly is not treated.⠀

If the baby is not treated, they may be psychologically negatively affected as they grow up. Since they look aesthetically differently than the children around them, their psychology will be negatively affected. Cleft lip-palate should be treated just like any disease.

It is highly important that children with congenital cleft lip-palate are operated on at suitable ages by experienced Plastic and Reconstructive and Aesthetic Surgeons using suitable methods. On the other hand, these children must be addressed with a team approach. It would be better if this team incorporated various specialists such as a nutrition specialist, ENT specialist and an Orthodontist.

Lip deformities must be corrected when the baby is 3 to 6 months old. Correction of lip deformity at an early stage will improve both the aesthetic appearance of the baby and the psychology of the family and realign the baby’s crooked teeth curve. The nasal wings will have also been corrected to some extent.

The suitable age range for correction of palate deformity is 9 to 12 months. Correction of the palate involves closure of the cleft in the palate, allow for easier feeding of the baby, and minimize the risk of acute otitis media and pneumonia. Correcting the palate before the child learns how to speak will allow the child to learn how to speak normally and prevent them from making coding errors at the stage of perceiving their own voice.  ⠀

The nasal deformities seen in children with cleft lip-palate can be corrected with surgery using special techniques after the age of 16 to 18. ⠀

This way, it is possible to minimize and prevent psychological and social issues when a child born with such anomalies can speak normally and have functioning and aesthetic nose, lips and chin.

Cleft lip occurs due to inability of the peaks of the upper lip to join at the base of the nose when the face of the baby develops during pregnancy. If this deformity continues in the palate inside the mouth, a cleft palate also occurs. These congenital anomalies are seen in one in 750 babies on average. Cleft lip may be unilateral or bilateral or together with cleft palate. Sometimes, isolated cleft palate may occur without cleft lip. ⠀

These deformities may require a series of surgeries spread over the years. All cleft lip-palate cases can be corrected in appearance and function if the intervention is made on time.

Children with cleft lip-palate may have congenital or acquired deformities of different soft tissues and bones. The problems may vary depending on the severity of the cleft. These patients must be regularly checked by plastic surgeons starting from birth.

With use of the orthodontic appliances made by orthodontists, the openings in the lip and the palate are narrowed down to give a better look. Furthermore, the nasal deformities are also corrected. This way, it is possible to obtain the best possible result after the surgery. For this reason, the cooperation between the plastic surgeon and the orthodontist is important in terms of obtaining the best results in these patients.

The rate of success of the treatments is relatively high considering the recent important developments in the treatment of cleft lip-palate. If the cleft lip is corrected when the baby is 3 to 6 months old and the cleft palate is corrected when the baby is 9 to 12 months old using the measures and treatment approaches starting from the birth of the baby, the deformities can be corrected with minimum scarring and any speech disorder is prevented before it develops. Nasal deformity usually concurrent with cleft lip-palate can be corrected with surgery using special techniques after the age of 16 to 18, obtaining results that minimize the social and psychological problems that the child can experience due to such deformity.  ⠀

In this long-term process, the success rate of the treatment is relatively high if a team of specialists from different branches cooperate in the treatment of cleft lip-palate and any accompanying deformities.

Treatment of cleft lip-palate basically targets providing for functional speech. Other targets include prevention of passage of air and water between nose and mouth, protection of hearing due to middle ear disorders, correction of mid-face development, and creation of fine looking and functional upper teeth frame. ⠀

Patients who are not treated properly or untreated for cleft lip-palate may develop otitis media, pneumonia and retarded development later in life. After lip or palate correction surgeries, secondary correction surgeries may be required later in life. Functional and aesthetic procedures for the nasal deformities that generally accompany the existing anomaly should be planned for after the age of 16 to 18. Any delay in orthodontic examination and related intervention may cause obtaining unsuccessful treatment results. As the patient grows older, bone development problems may be experienced and the corrective surgeries (for the upper and lower jaw and nose) may extend into the adolescence.

Treatment of Cleft Lip-Palate is a long-term process. It is an anomaly that requires a multidisciplinary approach starting from the birth of the baby. Therefore, treatment of cleft lip-palate is a team work. ⠀

This team consists of a plastic and reconstructive surgeon in particular, and an orthodontist, speech therapists, geneticist, ENT specialist, pediatrist and anesthesiologists, as well as an audiologist, psychologist and nurses.

Plastic, reconstructive and aesthetic surgeons specialize in correction of deficiencies and deformities in bone and soft tissues of babies with cleft lip-palate from birth until adolescence. ⠀

Orthodontists coordinate with surgeons and other specialists before and after the operation in order to provide for the suitable teeth and jaw structure. Orthodontists also play an important role in post-operative follow-up.  ⠀

ENT specialists get involved in the treatment of airway obstruction problems, loss of hearing, ear infections, sinus and nasal diseases, which are common in children with cleft lip and palate.

Furthermore, they work in close cooperation with the other specialists in the cleft lip-palate team regarding sleeping, hearing, speech and chewing problems.

Speech therapists work to improve and rehabilitate the speech of children with cleft lip-palate after the surgery.

Your baby might be born with cleft lip and palate. Whereas genetic factors are responsible for occurrence of cleft lip-palate it may also develop due to various factors such as radiation exposure of the mother within the first trimester of pregnancy, psychological trauma, use of drugs, vitamin deficiency and excess among.

Development of organs and the face in the womb takes place with the joining of three main parts; first the lower and upper lips and then the palate is shaped when the middle part and the two parts on the sides join together. Sometimes, this joining is not proper and different clefts may form.

Appearance and functions can be corrected with timely and proper interventions in babies born with Cleft Lip and Palate.

Cleft lip-palate is a rather common deformity caused by a combination of a number of factors. It is believed that some of them include use of medication, vitamin deficiencies, viral infections, smoking, alcohol consumption and genetics. Consanguineous marriages may increase the chances of passing the deformity down with the genes.

If parents who do not have a cleft lip-palate had their first baby with a cleft lip-palate, the chances of occurrence of the same anomaly is 4%. If parents who have cleft lip-palate have a first child with a cleft, the chances of having a second child with a cleft increase over 10%.

Both sides of the middle part of the upper lift (philtrum) have the sides of the lip. Cleft lip deformity occurs when the philtrum and the sides of the lip do not join. Cleft lip may be unilateral (Unilateral Cleft Lip) or bilateral (Bilateral Cleft Lip) with clefts in both sides of the philtrum. Additionally, the cleft side can be seen as a groove immediately above the red part of the upper lip whereas it can also be a cleft cutting the entire lip up to the base of the nose. Furthermore, some patients may have a cleft in their upper jaw, too. ⠀

The shape of cleft lip is not the same in every baby. Some babies only have a cleft uvula, and some may have an entirely cleft soft palate. The cleft may start in the uvula and cover the entire palate up to the teeth in some patients. ⠀

Families of babies born with a Cleft Lip-Palate should be informed in detail by the doctor about the anomaly and its treatment when the anomaly is diagnosed in the womb or after giving birth. When families have sufficient information about the solution of the anomaly, their anxiety will subside. ⠀

Some patients may have a cleft lip and cleft palate at the same time or only one of them. ⠀

Cleft lip occurs when the upper lip and the base of the nose of the baby do not join during pregnancy. The problem in babies with a cleft lip is that they have deformed lips and nose. This is also frequently accompanied by a cleft palate. Cleft lip-palate is a very common anomaly as cleft palate is seen in 1 in every 2,500 babies and cleft palate is seen 1 in every 1,000 babies. Families should know that they are not alone in this problem and treatment of cleft lip-palate is possible.

The most important problem in babies with a cleft palate is breastfeeding. The baby may not be able to breastfeed. With the support to be received from Orthodontics, a prosthesis to place into the mouth can be used in order to ensure the baby is breastfed properly.

Additionally, families who have a baby with a cleft palate should have their babies have a hearing test. Due to fluid accumulation in the middle ear in these babies, hearing loss may develop.

Cleft lip-palate deformity is not an incurable disease. It is treatable when responded in time and by a specialist. There may be other deformities that accompany the cleft lip-palate, which is a congenital anomaly. Cleft Lip-Palate may be accompanied by certain heart diseases, malformations in the hands and feet, skull and brain deformities or genetic organ disorders. A baby born with a cleft lip-palate should be first evaluated for the other deformities that may accompany the anomaly. The relatives of the patient should be informed in detail on the anomaly. The baby with a cleft lip-palate should be closely followed up by a cleft team including a Plastic Surgeon, ENT Specialist, Orthodontist and Pediatric Geneticist.

The biggest concern of the families of the babies with a cleft lip-palate is how to feed the baby. They worry that the baby cannot suck and swallow or even have difficulty breathing due to the cleft. The cleft lip-palate does not negatively affect the swallowing and breathing functions of the baby. These babies can easily swallow the liquid food fed into their mouths. In the absence of any accompanying problems such as small lower jaw, these babies will not have any difficulty breathing. ⠀

It is wrong to believe that the babies born with this anomaly will not breastfeed. A significant percent of babies with a cleft palate can breastfeed. The parents are asked to breastfeed them in an almost upright position, breastfeed them more frequently, burp the baby and always ensure that he sleeps on his side. Furthermore, babies with a large cleft in their palates may be supported with a temporary palate appliance to cover the palate or special nursing bottles. ⠀

Babies with a cleft lip-palate must be fed more frequently than normal babies (every 2 to 2.5 hours).

The baby must be fed a teaspoon of water to wash inside his mouth.

Existence of cleft lip-palate can be detected with USG at the end of the first trimester of pregnancy; however, no intervention can be made before the baby is delivered. ⠀

Whereas cleft lip-palate is the most common congenital anomaly of the head and neck region, timely interventions by a team of specialists that work together and in harmony can help the child have functional speech and improve the middle face development until school age. 

Treatments of a baby born with a cleft lip-palate involve a long-term process from birth until adulthood. During this long-term process, different disciplines take on the patient at the same time or at different times and continue the treatment.