Cleft lip, commonly known as “harelip”, is a congenital malformation in which the upper lip is cleft. Cleft lip is the most common congenital malformation of the oral and maxillofacial region, and is often associated with cleft palate. The prevalence of cleft lip and palate in China is on the rise, with a male-to-female ratio of 1.5:1, with more males than females. According to a large number of experimental studies and epidemiological findings, it may be due to the influence of multiple factors rather than a single one. Broadly speaking, it can be divided into two aspects: genetic and environmental factors, and is related to nutritional, genetic, infectious and endocrine factors.
Common international classification of cleft lip
1.Unilateral cleft lip
Unilateral incomplete cleft lip (the cleft is not cleft to the bottom of the nose)
Unilateral complete cleft lip (the entire upper lip to the base of the nose is completely cleft)
2.Bilateral cleft lip
Bilateral incomplete cleft lip (both clefts are not split to the bottom of the nose)
Bilateral complete cleft lip (complete cleft of the upper lip to the bottom of the nose bilaterally)
Bilateral mixed cleft lip (complete cleft on one side and incomplete cleft on the other side)
Common domestic classification of cleft lip
1.Unilateral cleft lip
Ⅰ degree lip degree: limited to the red lip part of the cleft.
Ⅱ degree cleft lip: the upper lip is partially cleft, but the nasal base is still intact.
Ⅲ degree cleft lip: the entire upper lip to the bottom of the nose is completely split.
2.Bilateral cleft lip
Both sides are classified separately according to the method of unilateral cleft lip classification, such as bilateral Ⅲ degree cleft lip, bilateral Ⅱ degree cleft lip, left Ⅲ degree right Ⅱ degree mixed cleft lip, etc.
Clinical classification of cleft palate
The following clinical classification methods are mostly used according to the degree and location of clefting of the bone, mucosa and muscular layer of the hard and soft palate.
(i) Cleft soft palate
Only the soft palate is cleft, sometimes limited to the palatal lobe. It is not divided into left and right, and is usually not accompanied by cleft lip, and is clinically more common in females.
(ii) Incomplete cleft palate
Also known as partial cleft palate. A complete cleft of the soft palate is accompanied by a partial cleft of the hard palate; sometimes accompanied by a unilateral incomplete cleft of the lip, but the alveolar process is often intact. There is also no right or left distinction in this type.
(C) Unilateral complete cleft palate
The cleft is completely cleft from the palatal lobe to the incisal foramen, and it reaches the alveolar process obliquely and connects with the alveolar cleft; the edge of the cleft on the healthy side is connected with the nasal septum; sometimes the cleft disappears and only the cleft remains, sometimes the cleft is very wide; it is often accompanied by ipsilateral cleft lip.
(iv) Bilateral complete cleft palate
It often occurs at the same time as bilateral cleft lip, and the cleft is in the premaxillary part, each oblique cleft to both sides, reaching the alveolar process; the nasal septum, premaxillary process and prelabial part are isolated in the center.
Other cases of cleft palate
In addition to the types mentioned above, a few atypical cases can be seen: such as complete on one side and incomplete on the other; missing palatal lobe; submucosal cleft (hidden cleft); partial cleft of the hard palate, etc.
Treatment of cleft lip: Cleft lip revision surgery can be performed when the child is more than 3 months old and weighs more than 6 kg (not absolute, good nutritional status helps to tolerate surgery and postoperative wound recovery); hemoglobin is more than 100 g/l; white blood cells are less than 1.2×109/l; and there is no upper respiratory infection or diarrhea in the last 2 weeks, and the surgery should be individually designed according to the child’s cleft lip.
Treatment of cleft palate: surgical repair of cleft palate, hearing follow-up and treatment, speech training, orthodontics in dentistry, and psychiatric and psychological treatment are required. Cleft palate repair can be performed when the child is 10 months of age or older and also has the following conditions: weight greater than 8 kg (not absolute, good nutritional status helps to tolerate surgery and postoperative wound recovery); hemoglobin greater than 100 g/l; white blood cells less than 1.2 x 109/l; and no upper respiratory tract infection or diarrhea in the last 2 weeks, so that the cleft palate repair can be completed before the age of 2 years if possible. The effect of postoperative speech is very obvious. If the cleft is severe and there is a possibility that a large area of bare bone will remain after surgery, the surgery can be delayed appropriately.
Reasons why feeding young children with cleft lip and palate is more difficult than normal children
Reason 1: Due to the cleft lip and palate of the child, the oral and nasal cavities are connected, and the negative pressure required for effective sucking cannot be generated because a complete airtight structure cannot be formed in the mouth.
Cause 2: Due to the change in the distribution and attachment of the muscles of the lip and palate, the development and tension of the muscles are insufficient. This causes tongue retraction; at the same time, tongue overdevelopment and tongue uplift cannot effectively wrap the pacifier during sucking.
Reason 3: Due to shortening or inability to lift the soft palate resulting in imperfect function of the soft palate which affects sucking and swallowing.
Effective feeding methods
Method 1: Pay attention to the position: (1) take a sitting position or 45b angle holding position, do not lie flat to avoid choking and coughing.
(2) Adopt face-to-face feeding mode to facilitate observation.
(3) Use the prone position so that the nasal cavity is above the mouth without choking and coughing.
Method 2: Block the cleft lip area with your finger to help the lip close while the child is sucking.
Method 3: Use a plastic bottle with a cross-shaped opening because the cross-shaped opening will only open when pressed and the child will not choke.
Method 4: Use squeeze feeding, i.e. buy bottles or syringes or droppers that can be squeezed for feeding.
Method 5: Train the cheek and tongue by blowing up balloons, sucking on the pacifier or massaging the muscles.
Method 6: Place the pacifier in a non-cracked area to avoid excessive local stimulation.
Method 7: Early orthodontic treatment, such as wearing a Hotz aligner made of both hard and soft resin material, covering the entire alveolar ridge and hard and soft palate, which creates negative pressure in the mouth and improves tongue movement, has shown significant improvement in feeding.
Significance of choosing spoon feeding after surgery
Reason 1: Sucking on a pacifier after surgery can cause excessive local tension in the wound, resulting in incomplete wound healing.
Reason 2: Postoperative wound pain and reluctance of the child to suck on the pacifier may result in insufficient feeding.
Method 1: Use a flat-bottomed spoon instead of a deep-bottomed spoon and avoid metal products.
Method 2: Start with a small amount of food and gradually increase it.
Things to note after surgery
(1) Do not feed food that is too hot.
(2) A small amount of warm water should be taken after feeding to clean the mouth.
(3) Avoid the stimulation of residues and hard food.
(4) Keep the wound locally clean and dry.
(5) Avoid excessive crying and scratching and collision with the wound site.