On the Internet and on Twitter, we often see various news about babies with cleft lip and palate being abandoned, or abandoned on the roadside hoping for a kind-hearted person to adopt them, or just thrown into the river to cut off their ties. The followers are mostly critical of the parents, all kinds of abuse …… after the righteous indignation, calm down to think, why do parents abandon their own flesh and blood? What is the pain? It is because the child’s facial disfigurement, can not be cured, no money to cure, afraid of the child, and even the family to be discriminated against, afraid that the child will grow up to resent themselves? So, simply do it on his behalf to erase his life? If it is for such a reason, the child is really wronged. Because, after regular sequential treatment, children with cleft lip and palate can live like normal children, and their appearance, eating and pronunciation can be restored to near-normal levels, and children with cleft lip and palate can have a life full of sunshine and laughter.
In fact, the incidence of cleft lip and palate is very high, according to the detection data from 1996 to 2000, 1.625:1000, which means that there is 1 cleft lip and palate child in every 600-700 newborns. Because of the high incidence, the impact on the physical and mental development of the affected children, the high level of social concern, and the fact that this deformity is treatable and the treatment technology is relatively mature, there are many international or domestic charitable funds that are willing to fund the initial and second-stage repair surgeries for cleft lip and palate patients. The “Smile Train” in the United States, and the “Operation Rebirth” project funded by the Li Ka Shing Foundation.
Here is a detailed introduction to the “Operation Rebirth”: “Operation Rebirth – National Cleft Lip and Palate Surgery Rehabilitation Program for Children from Poor Families” is a nationwide program funded by the Ministry of Civil Affairs of the People’s Republic of China and the Li Ka Shing Foundation. It is a large-scale public welfare project implemented by the Ministry of Civil Affairs of the People’s Republic of China and the Li Ka Shing Foundation nationwide. At present, the program subsidizes the full cost of medical examination, surgery and rehabilitation for minors with cleft lip and palate and related deformities, aged 0 to 18 years old, from poor families nationwide, and subsidizes the transportation costs of food and lodging for them and one accompanying person, with a total project funding of 100 million RMB. To ensure the quality of surgical rehabilitation for children with cleft lip and palate, the program selects 33 medical institutions nationwide to provide surgical treatment and rehabilitation guidance for children with cleft lip and palate from poor families.
What are the conditions for first-time cleft lip and palate repair surgery? What kind of results can be achieved in the initial cleft lip and palate surgery?
Usually unilateral cleft lip at 3 months of age and bilateral cleft lip at 6 months of age, the child should weigh not less than 10 pounds; hemoglobin should not be less than 10g/100ml; white blood cell count should not be higher than 10^4/mm~3; and the child should not be earlier than 10 weeks old. This is based on a combination of the child’s nutritional development, the body’s ability to tolerate the surgery, the certainty of the delicate operation and the impact of the surgery on the child’s facial development. Primary cleft lip repair includes repair of the red and white lips, reconstruction of the orbicularis oris muscle, and initial correction of the nasal deformity. The scar of the cleft lip surgical incision will be more pronounced, red and hard within 2 weeks to 6 months after surgery, and will begin to fade after 6 months and stabilize in 2 years, but the surgical scar will never completely disappear. For many children, with delicate surgery and proper post-operative care, the scar is not very visible. These inconspicuous scars are largely invisible as adults when men can grow beards and women can wear makeup.
The goal of cleft palate surgery is to close the cleft and restore the normal critical anatomy and function of the palate necessary for speech. Early surgery may affect the development of the jaw, yet restore its speech function ideally; late surgery affects development less, but speech outcomes are not yet ideal. The more common view is that restoration of voice function is the primary goal, while the sea of jaw deformities caused by surgery can be corrected by orthodontic and orthognathic treatment. Therefore, the timing of primary cleft palate surgery is usually between 1 and 1.5 years of age, before the child begins to learn to speak. Primary cleft palate repair involves, repairing the cleft, muscle reconstruction, lengthening the soft palate, and reconstructing the uvula, which means creating a favorable anatomical environment so that the child’s palatopharyngeal movements can separate the oral and nasal cavities without air leakage when speaking and swallowing.
Does the treatment of cleft lip and palate patients end after the first stage of surgery? The answer is no, because as the child grows and develops, a series of secondary deformities will arise, which require second-stage revision surgery at the appropriate time; if there is a cleft alveolar process, bone grafting surgery is required at the age of 9 to 11 years; if the maxilla is underdeveloped, orthognathic surgery is required at the age of 16 to 18 years. In addition, the treatment of cleft lip and palate also requires the joint participation of physicians from disciplines other than surgeons, such as orthodontics to coordinate the dental arch, ENT to participate in the consultation of related diseases, speech therapy for cleft palate patients, psychological care for the children, etc. Therefore, the treatment of cleft lip and palate is an orderly and comprehensive treatment.