Congenital cleft lip and palate is the most common congenital malformation in China, and it is a multifactorial genetic disease related to genes and environment, and its specific etiology is still uncertain. Cleft lip and palate can affect the child’s appearance, speech, swallowing, occlusion, jaw growth and development, and hearing and other oral and maxillofacial organs except vision. More seriously, this deformity will also affect the psychological development of the affected children, leading to psychological disorders and hindering their social interaction, study, work and life. West China Stomatological Hospital Cleft Lip and Palate Clinic has a cleft lip and palate clinic, a cleft lip and palate ward and a pathological voice correction room, and has excellent medical and nursing staff to provide good treatment conditions for children with cleft lip and palate. It is one of the earliest units in China to carry out the treatment of cleft lip and palate, undertakes the most scientific research projects at the national, provincial and ministerial levels, and improves and innovates the treatment of cleft lip and palate, and it is also the designated hospital of cleft lip and palate of the U.S. Smile Train, and the training center of surgery and anesthesiology doctors. It is also the designated hospital for Cleft Lip and Palate of American Smile Train and the training center for surgeons and anesthesiologists. The treatment of cleft lip and palate is to choose the best treatment plan according to the different stages of the child’s growth and development, to treat various deformities, in order to achieve the best treatment effect, the least secondary deformities, and finally to achieve the goal of treatment with good form and function. Etiology At present, there are many theories at home and abroad, but none of them is certain. For most scholars can generally accept is the multifactorial comprehensive role of the theory that cleft lip and palate is a multifactorial genetic disease, the specific etiology can be divided into two categories: genetic factors and environmental factors, some clinical and laboratory research work shows that: some cleft lip and palate occurs due to the environment, there are written due to the genetic reasons, but the vast majority of them are due to the common role of genetic and environmental causes. The vast majority are due to a combination of both genetic and environmental causes. Environmental factors. These include the maternal environment, infections, medications, bad habits, and nutrition, among many others. There is still no definitive answer as to what exactly can cause cleft lip and palate, or what causes can be avoided if they are avoided. Treatment of Cleft Lip There is a saying that pregnant women can’t eat rabbit meat or even see rabbits, and it is believed that contact with rabbit meat and rabbits during pregnancy will give birth to a child with a “hare lip”, which is obviously wrong although it has been passed down in ancient and modern times and at home and abroad. Can not see the rabbit argument is even more unfounded Sichuan people like to eat rabbit, but the incidence of cleft lip and palate is not higher than elsewhere this is just a far-fetched argument, is “not find the cause of the reason”. There are a number of such claims, which can be categorized as superstitions When people cannot explain a natural phenomenon, they will attribute its cause to some mysterious forces, which is obviously unscientific and very harmful. So parents should never feel guilty or blame themselves for having a child with a cleft lip. Surgery for cleft lip is usually performed when the child is about 6 months old and can be hospitalized for surgery when the weight and tests are up to standard and there are no other abnormalities. The outcome of the surgery is the most important element of concern for parents and can be explained in several ways. First of all, cleft lip must be surgically repaired, there is no other way to treat; West China Stomatological Hospital specialists are good at repairing cleft lip deformity in various ways, and on the basis of their familiarity with various surgical methods, they have constantly improved them, and formed a new surgical style with distinctive characteristics of West China, which has been known as “West China’s improved method” and “Shi Bing method” both at home and abroad. It is known as “Huaxi Improved Method” and “Shi Bing Method” at home and abroad. The result of surgical repair can maximize the restoration of anatomical structure and function, close the fissure, and reduce complications. This type of revision surgery not only corrects the deformity so that the child’s face grows and develops in a normal way, but also ensures normal psychological development, and in a sense, a healthy psychology is far more important than correcting the deformity. Secondly, surgery can close the cleft, but it is impossible to make a cleft lip look like a normal one. For example, if we want to mend a piece of clothing, we can sew up the opening, but even the most skillful tailor cannot mend the clothing without any marks as if it were a new piece of clothing. The repair surgery for cleft lip is much more complicated than mending a piece of clothing, involving each child’s specific anatomical structure, the shape and severity of the cleft, the amount of local soft tissues, and individual development and so on, so parents should not think that their children will be back to normal after the surgery, but should realize that the first thing that needs to be addressed is the closure of the cleft, and the shape of the cleft to be close to perfection is still to be determined by the second-stage surgery in the future. As for how to close the cleft, it still needs to be corrected by the second stage of surgery in the future. In some developed countries, the surgical treatment of cleft lip will continue into adulthood, and the final shape of the cleft lip will be formed after many operations. Again, the surgery will leave a scar. Any surgical incision will leave a scar after healing, that’s for sure. However, parents can take some measures to make the scar is not too big and less obvious, specific measures are: 1, reduce crying, collision and other adverse stimuli 2, frequent cleaning, keep the incision dry and clean After discharge, parents can also often give the child’s lips to do the massage, the specific method is: with the thumb inside, forefinger outside, gently clamp the lips of the surgical incision site, feel where the hardness of what place on the massage what place. At the same time, you can apply a little scar-softening medication to the outside of the lips, which will also help to reduce scar formation. After the child is discharged from the hospital, the red edge of the lip may become uneven due to growth and development or the contraction and pulling of the scar, or the scar formation may be more obvious, which is a normal phenomenon, and there is nothing to be nervous about. The solution is to contact your doctor one year after discharge to prepare for a second stage of surgery. A cleft palate, commonly known as “wolf’s throat”, is a cleft in the upper palate (commonly known as “heaven” or “upper hall”) of a child’s mouth. In mild cases, the cleft is only in the uvula of the soft palate (commonly known as the “little tongue”), while in severe cases, the cleft is in the entire palate from the soft palate to the hard palate. In severe cases, the entire palate from the soft palate to the hard palate is cleft. At this point, the child’s mouth and nasal cavity are not closed by the normal mouth cover, resulting in the so-called “wolf’s throat”. If the main effect of a cleft lip is cosmetic, the main effect of a cleft palate is functional. The main hazards of cleft palate are: feeding difficulties for the child, resulting in malnutrition, and the development of the whole body will be affected; the child’s speech dysfunction, and the ambiguous pronunciation will hinder the child’s normal learning, social interaction and the formation of a healthy mentality. West China Stomatological Hospital adopts the international advanced level of functional cleft palate reconstruction method – Sommerlad palatine sail lift muscle reconstruction±modified Lan’s method±buccal mucosa flap transfer repair method. During the surgery, the nasal mucous layer is not cut, the wing hook is not chiseled off, the ectopic palatal raphe muscle layer is dissected and the palatal sling is reconstructed, the buccal mucosal flap is used to repair the exposed area at the back of the flaccid incision, the bony surfaces of the hard palate on both sides are not exposed as much as possible or are less exposed, and absorbable thread is used to suture the wound. Therefore, it has the advantages of small trauma, good soft palate lifting movement, good voice improvement, small influence on maxillary development, fast recovery of the child after surgery, and reduction of average hospitalization days (3-4 days). It is highly praised by parents and peers and is widely recommended for clinical use. Possible complications after surgery: 1. Postoperative bleeding. A small amount of blood oozing may occur after the operation of both flaccid incisions, which mostly stops automatically after a few days. 2.Pain in the throat is most noticeable in the first 3 days after surgery and may disappear on its own. 3.Palatal perforation after surgery. For the more common complications, mostly in the junction of hard and soft palate, the cleft is too wide p tension is too large or the infection of the trauma or the postoperative child’s loud crying, too early to eat a solid diet may cause cracking. 4, Infection. Due to the infection of the nasal side trauma or poor hygiene of the oral and nasal cavity, oral antibiotics can be taken to prevent infection. 5, poor nasal ventilation or snoring during sleep, the most obvious in the first week after surgery, and then with the gradual decline of the swelling of the surgical area and reduce and disappear. 6. Occasional earache. It may be caused by postoperative edema around the Eustachian tube, which will disappear gradually with the swelling subsiding. After the repair of cleft palate, children sometimes still have the phenomenon of water flowing out of the nose when drinking water. In addition to the exclusion of the complications of perforation of the palate, the main reason is that most of the children with cleft lip and palate have alveolar synostosis, that is, the maxillary anterior teeth are partially defective in the alveolar ridge, resulting in oral-nasal vestibular fistula, which requires two-stage restoration. Treatment of cleft alveolar ridge The presence of cleft alveolar ridge affects the child’s development and oral hygiene, causing blocked eruption or misaligned eruption, which affects the facial appearance and chewing function. However, surgical repair at the same time with cleft lip and palate will easily lead to the restriction of maxillary growth and development, so we advocate that the best time for repair is at the age of 8.5-12 years old, i.e., the root of the cuspid is 1/2-3/4 of the way through the formation of the cusp. At this time, the child’s own iliac bone can be transplanted to rebuild the alveolar process, and most of the cuspids can erupt normally, and the growth and development of the maxilla will be minimally interfered. After the cleft palate is repaired, the child’s pronunciation may not be completely satisfactory immediately, because the surgery only restores the child’s oral anatomy to normal, but to achieve the recovery of speech function, it is necessary to go through the later treatment. Speech training is particularly important. After the surgery, the muscles of the palate have to be exercised. The original pathological articulation pattern of the child has to be corrected, and the normal articulation pattern has to be gradually learned and formed, so that the articulation function can be gradually normalized. If no speech training is done, the child will not be able to pronounce properly due to the poor functioning of the palate muscles, or the child will still have the same pathological articulation pattern as before the surgery and will continue to have unclear speech, which will greatly reduce the effect of the surgical treatment. Therefore, after the cleft palate repair surgery, children are required to start speech training under the guidance of our speech trainer. (For details, please refer to Discharge Instructions and Speech Therapy section.) Secondary deformities after cleft lip and palate surgery: It is very difficult for cleft lip and palate patients to achieve a completely satisfactory result after initial rehabilitation, especially for cleft lip patients. This is because, although the deformity of each patient with cleft lip and palate is similar on the surface, the deformity of each child is actually different, which undoubtedly increases the difficulty of cleft lip and palate surgical reconstruction; on the other hand, the patients with cleft lip and palate reconstruction are children, whose faces are still in the process of development, and whose long-term effects cannot be defined at the time of the surgery, and the final effect cannot be judged completely by the good or bad situation at that time after the surgery. In cases with good results at that time, there may also be poor results in the later stages, while cases with unsatisfactory results at that time may also have good results in the later stages with the changes in growth and development; there is also a very important factor that some tissues and structures cannot be touched at all during the first surgery, and damaging them will bring about very serious deformities in the later stages, which limits the success rate of the surgeon in performing the surgery. success rate at one time. Due to the existence of the above factors, it is decided to achieve satisfactory treatment results, often need to go through another or even multiple operations to realize the inevitability. 2, the significance of the second phase of restoration: love of beauty, all people have. The shape of nose and lips is an important factor in determining the beauty and ugliness of appearance, and a small deformity can easily damage a person’s external image. Children with postoperative deformity of cleft lip may not feel that there is any great harm when they are young, but with the growth of their age, their psychology and social life will be more and more affected. Some people pointed out after statistical analysis of secondary deformity cases after cleft lip surgery that 84% of patients with secondary lip and nose deformity after cleft lip surgery had obvious psychological obstacles, which directly affected the employment and social interaction of patients, so it was very necessary to carry out the second-phase repair. Indications for two-phase restoration: postoperative cleft palate: postoperative perforation, postoperative recanalization; residual alveolar fissure, postoperative dysphonia caused by palato-pharyngeal closure insufficiency and postoperative secondary deformity of the maxilla (mid-face concavity). Postoperative cleft lip: excessive loose/tight upper lip, wide upper lip, insufficient height of the middle portion of the upper lip, inconspicuous middle portion of the upper lip; inconspicuous arch of the lip, untidy lip margins, bulging lip muscles, obvious scarring of the lip, collapsed tip of the nose, and asymmetry of the nostrils on both sides. 4, the timing of the second phase of restoration: postoperative perforation of cleft palate, postoperative cleft palate and lip scarring for six months after surgery. Postoperative dysarthria, postoperative lip deformity of cleft lip, very obvious nasal tip collapse and obvious asymmetry of nostrils on both sides of the nose are about 5 years old in preschool. 12~14 years old should be re-examined to see if they need to be operated again. Surgery for cleft alveolus is best performed at 9-11 years of age, before the eruption of the cuspids. For those who need orthognathic surgery for secondary deformity of the maxilla after cleft palate surgery (depression in the middle of the face), the best time for surgery is after the age of 18, when growth and development have stopped. 5. The restoration of deformity after cleft lip and palate surgery is more difficult than the first restoration. There are many surgical designs and restoration methods, and the specific program should be combined with the characteristics of the patient. Most of the surgeries can be done by using local tissues, while some of the surgeries need to take the bone from other parts of the body, and in some cases, it is necessary to repair the deformity by using artificial biomaterials. Timing and Methods of Cleft Lip and Palate Sequential Treatment Time (Age) Treatment Content Main Treatment Methods 1~2 months after birth Preoperative Orthodontic Treatment Latham Orthotic Appliance, Hotz Plate 3 months Gingivo-Osteoplasty/Labial Adhesion Skoog’s Method, Randall’s Method 6 months Unilateral Cleft Lip ± Cleft Hard Palate Repair Huaxi’s Modified Method 6~9 months Bilateral Cleft Lip Repair ± Cleft Hard Palate Repair Huaxi’s Modified method 1~2 years old Palatoplasty Von Langenbeck/Sommerlad palatofacial raphe reconstruction – Huaxi modified method Middle ear function examination and treatment Tympanic membrane implantation, etc. 3~4 years old Cleft palate phonotherapy Phoniatrics 4~5 years old Hard palate repair (only repair of cleft soft palate in children at the age of 1-2 years old) Plough flap method 5~6 years old Secondary deformities after microfacial cleft lip repair Z-plasty, V-Y plasty method Z-plasty, V-Y-plasty Correction of cleft palate and palatopharyngeal insufficiency Pharyngoplasty, re-palatoplasty 9~11 years old Repair of alveolar synostosis Bone grafting with iliac bone cancellous material as the mainstay of repair 11~12 years old Orthodontic treatment of cleft lip and palate malocclusion Restoration of arch and tooth shape and position Phase II correction of cleft lip and palate rhinomalacia The Huaxi modification 16~18 years old Rehabilitation of cleft lip and palate secondary to bony deformities of the teeth and the alveolar surfaces Maxilla Maxillary Lefort I osteotomy or mandibular osteotomy with oblique osteotomy 17~19 years old Rehabilitation of cleft lip and nasal deformity Septoplasty, bone and cartilage grafting.