After many years of development, the treatment of cleft lip and palate is now a relatively mature sequential treatment model. It is a comprehensive process involving multidisciplinary specialists (pediatrics, psychology, orthodontics, maxillofacial surgery, plastic surgery, ENT, etc.) to treat children with cleft lip and palate according to a certain procedure in accordance with the growth and development process of the child.
The details are as follows.
Initial consultation: 2 to 4 weeks after birth.
Preoperative orthodontics: beginning after the initial consultation.
Unilateral cleft lip revision: around 3 months of age
Bilateral cleft lip revision: around 6 months of age
cleft palate revision: around 10 months to 1 year of age
language assessment and training: starting after 2.5 years of age and every 6 months until normal
Treatment of palatopharyngeal closure insufficiency: preschool age (5 to 6 years)
Cleft alveolar implantation: 5 to 9 years of age
cosmetic lip and nose: after 5 to 6 years of age, depending on the case
orthodontics: when mixed or permanent teeth are formed
Ear, nose and throat: regular follow-up of the middle ear after 6 months.
Timing of cleft lip and palate surgery and common repair modalities.
1.Unilateral cleft lip
(1) Microminiature cleft lip with intraoral incision 1-3 months after birth and human mid crest revision, no obvious scar in postoperative appearance.
(2) I° cleft lip, 1-3 months after birth, Millard II type, which is more beautiful in static and dynamic (such as crying, laughing, etc.) appearance after surgery.
(3) Ⅱ° cleft lip 1-3 months after birth, Millard II type, the postoperative static and dynamic (such as crying, laughing, etc.) appearance is more beautiful.
(4) Ⅲ° cleft lip 1-3 months after birth, Millard II type, both static and dynamic (such as crying, laughing, etc.) appearance after surgery are more beautiful.
2.Bilateral cleft lip
(3) The Millard II method and the modified full-length anterior lip method are used from 4 to 6 months after birth, and the upper lip is not tense and the upper and lower lip proportions are more harmonious after surgery, while the maxillary development is less inhibited than other methods.
3.Cleft palate
(1) recessive cleft palate 10 months after birth – 1 year old Sommerlad palatal sail reconstruction method or Furlow method; good postoperative improvement in language function and less suppression of maxillary development.
(2) I° cleft palate, 10 months-1 year postnatal Sommerlad palatal sail reconstruction or Furlow method; good postoperative improvement in speech and minimal inhibition of maxillary development.
(3) Ⅱ° cleft palate 10 months-1 year postnatal Sommerlad palatal sail reconstruction with modified Lang’s, Furlow’s and two-flap methods; good postoperative improvement in speech and minimal suppression of maxillary development.
(4) Unilateral Ⅲ° palatal cleft 10 months-1 year old Sommerlad palatal sail reconstruction method mainly combined with modified Lang’s and two-flap methods; good postoperative improvement in language function and minimal inhibition of maxillary development.
(5) Bilateral III° cleft palate flap method combined with mucosal flap of plow bone and palatal sail lift reconstruction from 10 months to 1 year after birth; good postoperative improvement of speech function and little suppression of maxillary development.
4, post-operative cleft lip deformity – after 1 year of post-operative repair, depending on the specific situation – specific surgical methods are used flexibly according to the deformity.
5, post cleft lip nasal deformity after 5 to 6 years of age, depending on the specific circumstances – specific surgical methods according to the child’s nasal deformity and age
6, palatopharyngeal closure incomplete pharyngoplasty 5 to 6 years of age after the palatopharyngeal muscle flap pharyngoplasty.
7, alveolar cleft bone grafting 5 to 9 years of age autologous iliac bone grafting.
8, orthodontic hybrid or permanent tooth formation when
9.Ear condition after 6 months of regular follow-up of middle ear condition.