Everyone desires to have a charming smile, but there is a group of people who are afraid to smile or even reluctant to meet people because of their congenital deformities: people with cleft lip and palate. When it comes to cleft lip and palate, the common reaction is “hare lip” and “open mouth”, which is the intuitive impression of cleft lip in appearance. Cleft palate, however, is a relatively new concept to people because it is hidden inside the mouth and is not usually seen directly.
Does cleft lip and palate have any other physical effects besides its unpleasant appearance? Can cleft lip and palate be completely cured? What should we do if we have a baby with a cleft lip and palate? Today we will take you closer to cleft lip and palate through the following questions to understand this common condition.
Standard lip shape
1.What is cleft lip and palate?
Congenital cleft lip is formed because the development of the upper lip is hindered during the embryonic period, resulting in the formation of a unilateral, bilateral or median cleft in the upper lip.
Congenital cleft palate is formed because the development of the protrusions fused to the palate during the embryonic period is hindered, causing the oral cavity to meet the nasal cavity, resulting in the formation of a cleft in the center of the palate.
Because these two malformations are often combined, we refer to them collectively as cleft lip and palate malformations. Cleft lip and palate is the most common facial cleft deformity, with an incidence of about 1/600 to 1/1000.
What other deformities may be associated with cleft lip and palate?
Some children with cleft lip and palate may have congenital heart disease or other craniofacial or limb deformities, but sometimes cleft lip and palate is just a manifestation of a systemic syndrome in the lip and palate, so children with cleft lip and palate should also have a systemic examination. Most patients with cleft lip and palate do not have a combination of mental retardation.
3.Why do you have cleft lip and palate?
Cleft lip and palate occurs due to impaired fusion of the protrusions of the lips and palate bilaterally during early embryonic development, but the exact causative factors are often unclear. A few children have genetic factors, most of them are due to the mother’s history of viral infections, drug poisoning, oxygen deprivation, nutritional deficiencies, chemical poisoning, radiation exposure, and sometimes the mother’s excessive emotional stress during pregnancy may also adversely affect the development of the fetus and lead to the occurrence of cleft lip and palate.
4.What are the effects of cleft lip and palate?
Patients with cleft lip and palate may suffer from maxillary dysplasia, maxillary recession, midface depression, and antimandibular deformity, and patients with cleft alveolar ridge may suffer from malocclusion, occlusion abnormalities, and tooth eruption disorders. Children with cleft lip and palate have difficulty sucking, some are prone to upper whistle infections, and some are also prone to ear diseases. Due to the defects in appearance and dysarthria, these children often develop serious psychological problems as they grow older.
5.Treatment principles of cleft lip and palate
The treatment of cleft lip and palate is a sequential treatment, which requires the participation of members of multidisciplinary physicians including plastic surgery, pediatrics, orthodontics, orthognathic surgery, otorhinolaryngology, speech therapy, psychology, etc. It is a process of mutual teamwork and step by step. Patients with cleft lip and palate have to undergo roughly 3 or more sequential surgical treatments to finally achieve satisfactory results.
6.Timing of cleft lip and palate surgery
At about 3 months of age
In good physical condition (the foreign standard is 10 weeks after birth, weight more than 10 pounds and hematocrit more than 10 grams – we can refer to that), unilateral cleft lip repair can be performed. In case of bilateral cleft lip, the surgery should be postponed until 6 months after birth.
6 months – 2 years
To complete the cleft palate repair surgery, the child has started to learn to speak by this time, and timely surgery before this time and post-operative speech training is essential for later articulation and speech. If cleft lip and palate are present at the same time, they should be operated on separately and the cleft palate should be repaired 6 months after the cleft lip surgery.
5-6 years old
Smaller soft tissue reconstructions can be done before going to school to facilitate psychological development after school.
After 9 years old
Bone graft repair of cleft alveolar ridge is done in order to fuse the cleft alveolar bone, close the hole between the oral cavity and the nasal floor, and to further improve the facial appearance by doing a simultaneous nasolabial deformity.
Despite the above-mentioned surgery in the early stage, most of the patients will remain with varying degrees of facial deformity or maxillary dysplasia as they grow into adulthood, requiring surgical correction of the labial-nasal deformity by a plastic surgeon or further improvement of the deformity and restoration of bite function by an orthognathic surgeon through osteotomy. Close cooperation with the orthodontist is required both before and after surgery. If the cleft palate patient still has post-operative palatopharyngeal closure insufficiency, no improvement in articulation abnormalities, and no significant effect of speech therapy, surgical correction is also required.