Cleft lip and cleft palate, commonly known as “hare lip” and “wolf’s throat”, affect the child’s appearance, while cleft palate affects the child’s pronunciation, i.e. cleft palate speech. Parents should pay special attention to their children’s nutrition and care because they have difficulty sucking and are prone to upper respiratory tract infections. Also, the patient’s appearance can easily bring about low self-esteem, which can affect work and life. Moreover, the presence of congenital cleft lip and palate in the child often brings psychological and mental distress to the parents of the patient at the same time.
Cleft lip and palate is a common congenital malformation. One child with cleft lip and palate is born for every 600-700 newborns, imposing a heavy psychological and economic burden on families and society. The cause of the disease is mainly due to the developmental arrest of the lip and palate mesodermal tissues of the embryonic oral cavity in the early stages (first trimester). The causes of the disease can be summarized into two main categories: genetic and environmental causes.
Along with the increasing standard of living and awareness of aesthetics, and with only 1-2 children per family, the desire of the affected children and their parents for satisfactory treatment requires us to improve the level of cleft lip and palate treatment, which is no longer possible with the traditional single cleft lip and palate repair surgery. This has led to the formation of a three-dimensional treatment model including orthopedic-surgical-orthodontic-speech for restoring normal anatomical and physiological functions, i.e. a multidisciplinary sequence of cleft lip and palate treatment. This requires the close cooperation of specialists in plastic surgery, speech pathology, oral and maxillofacial surgery, otolaryngology, psychiatry, gynecology, pediatrics and other disciplines.
The word “sequence” means order and sequence, which means the sequence of time; “column” means column of ranks, which means multiple disciplines are involved in this case from a horizontal view. Each participating discipline works in an organized manner according to the characteristics of different periods of cleft lip and palate, which is the “sequence”. There are seven main stages: fetal, newborn from birth to 4 weeks, infant from 1 to 12 months, toddler from 1 to 5 years, preschool, school age from 5 to 13 years, adolescent from 13 to 18 years and adult from 18 years and older. Each stage has its own focus content as the condition and treatment changes.
The fetal stage focuses on ultrasound identification of cleft lip and palate deformities, counseling, advice and reassurance for parents, and family education and support regarding fetal treatment options.
②The child is born at 1 to 3 months of age for a general examination, feeding education, and preoperative orthodontics if necessary.
③Unilateral cleft lip repair at 3-6 months of age and bilateral cleft lip repair at 6-12 months of age.
④Cleft palate surgery at 1.5-2 years of age and speech training at 1.5-2 years of age.
⑤ A comprehensive examination should be performed at the age of 6-8 years to consider the need for pharyngeal flap surgery and second-stage revision of secondary lip deformities based on their phonological pathology.
At the age of 14 to 16, the growth and development of children are basically completed, and they are facing the critical period of social development, which is the time of final correction of nasolabial deformity.
(7) Orthognathic surgical treatment after the age of 18.
Faced with a large number of first-time cleft lip and palate patients of different ages, the treatment plan for these patients should be discussed and developed by the treatment team as applicable to the individual patient, based on the deformity and prior treatment status of each patient, and as their financial ability permits.