Cleft lip is a congenital cleft caused by a developmental defect of the lip, which may be due to viral infection during the mother’s pregnancy, nutritional deficiency, genetics and other factors, the cause of which is not well understood. It occurs mainly on the right or left side of the upper lip or bilaterally, but upper median cleft and lower cleft lip are rare. Cleft lip can be accompanied by cleft alveolar ridge and cleft palate. Babies with cleft lip mainly have problems with nasal and lip deformities.
The degree of cleft lip is classified from a depression of the red lip tissue (occult cleft) to a complete cleft of the red and white lips to the base of the nose (complete cleft lip) as
1.Cryptic cleft lip: depression of the tissues of the red and white lips.
2.I degree cleft lip: only the red lip is cleft.
3.II degree cleft lip: red lip and part of white lip are cleft.
4.III degree cleft lip: The red lip and white lip are completely split to the bottom of the nose.
I. Treatment of cleft lip.
1.Pre-operative orthodontics.
By evaluating the cleft lip condition of the baby, it is decided whether the relationship between lip and bone on both sides of the cleft needs to be corrected by preoperative orthodontics, especially for babies with bilateral cleft lips.
2. Cleft lip repair time.
The overall condition of the baby with cleft lip and palate needs to be considered to set the surgery time (preoperative examination).
Unilateral cleft lip: usually repaired at the age of 3 months
Bilateral cleft lip: repair at about 6 months of age
Older cleft lip babies: Since the best time for cleft lip surgery has been exceeded, early surgery is needed to close the cleft and reduce the impact of the cleft on nasal and lip development.
3. Correction of nasal deformity.
Generally, after cleft lip repair, the baby’s nasal deformity will be greatly improved, especially the complete cleft lip will be improved the most, the size of nostril is basically comparable, the height of the lateral base of nasal wing is comparable as well as the nasal vestibule is restored after surgery, but due to the misalignment of nasal cartilage on the cleft side, it is impossible to solve the problem completely by cleft lip repair only.
Therefore, simultaneous intraoperative correction of nasal deformity as well as second-stage surgery to correct nasal deformity may be required. In addition to the simultaneous correction of nasal deformity by cleft lip surgery, the second stage of surgical correction of nasal deformity is mostly performed in preschool, after alveolar ridge implantation and after orthognathic correction of jaw relationship. Depending on the situation, the baby, parents and the doctor need to participate in the decision.
Second, preoperative care of cleft lip.
1.Feeding mode.
In order to reduce the impact of the baby’s sucking power on the wound after surgery, we should try to switch to using a spoon or a special cleft lip and palate bottle to feed the baby before surgery, and to switch to it about 3 days before surgery, so that the baby has a time to adapt to the change of feeding method.
Babies without cleft palate have normal sucking function and may be breastfed directly or bottle-fed before surgery, with breast milk being expressed and then fed to the baby.
Babies with cleft palate have problems with sucking and are very prone to choking and spilling milk from the nasal cavity when feeding. After switching to a spoon or special bottle, decide the amount of liquid per mouthful according to the amount of milk your baby swallows.
2. Mouth and face cleaning.
To have a clean environment around the incision for better healing after cleft lip surgery.
3.Correction of bad habits.
Some babies are used to sucking fingers and biting and tugging clothes. In order to prevent the baby’s fingers from unintentionally picking and tearing the wound after surgery, such bad habits should be corrected as much as possible before surgery.
Third, cleft lip post-operative care before removal of stitches.
1.Surgical incision.
Try to ensure the cleanliness and dryness of the lip incision
For the first two days after surgery, there is blood oozing from the incision, and the doctor will decide the time and way to change the lip dressing according to the affected area. After two days, there is usually a small amount of exudate, and the dressing is changed once in 1-2 days. The incision is coated with aloe vera gel and re-covered with a strip dressing.
When feeding the baby, large gulps of milk should be avoided to prevent milk from soaking into the dressing during feeding and choking out of the nostrils when the baby chokes and coughs. Parents should feed milk in small bites and wait for the baby to swallow all the milk in the mouth before feeding.
2. Nasal congestion.
After cleft lip surgery, nasal plugs may be placed in the baby’s nostrils for nostril shaping and nasal floor edge compression to promote incision healing; 2 days after surgery, the oozing blood from the incision may soak through the nasal plugs and turn black, and sometimes the baby’s nasal snot may also block the holes of the nasal plugs and prevent the baby from breathing.
The day before the removal of the stitches, according to the situation to decide whether to remove the nasal plugs to dry the incision at the base of the nose.
3. Protection of the lip incision.
Restrict the baby’s arm activities to prevent the baby’s fingers from stabbing and cracking the lip incision; as well as to prevent the impact of trauma such as bumps on the healing of the lip incision.
4. Use of antibiotics.
To prevent infection of the baby’s lip incision, in addition to local cleaning, prophylactic application of antibiotics is needed to prevent infection.
5.Stitch removal.
Unilateral cleft lip is generally removed on the 5th day after surgery, and bilateral cleft lip decides the removal time according to the healing of the incision, generally on the 5th-7th day after surgery.