1.When is the best time to treat cleft lip and palate?
(1) Unilateral cleft lip repair is performed around 3 months after birth, which basically follows the internationally accepted 3 “10” principles, i.e., weight up to 5 kg, age up to 10 weeks, and hemoglobin up to 10 grams. However, the timing of surgery is not absolute. If the child’s family is under too much psychological pressure, the child does not have serious combined malformations (such as congenital heart disease, etc.), and the hospital has professional neonatal anesthesia and neonatal monitoring, surgery can be performed in the neonatal period, and the relative scar is also light.
(2) Bilateral cleft lip repair is performed 6 months after birth, because bilateral cleft lip surgery takes longer and bleeds more than unilateral one, so the surgery is often properly backed off.
(3) Cleft palate repair is performed around 1 year of age.
(4) Pharyngoplasty is usually performed around 4 to 5 years of age, but this surgery is not always necessary. Before that, speech evaluation and nasopharyngeal fiberscopy should be performed, and pharyngoplasty is required if there is indeed incomplete pharyngeal and palatal closure.
(5) Osteotomy for cleft alveolar process is usually performed around 9 years old.
2.How should I feed before surgery?
Children with cleft lip and palate have difficulty in forming a complete closed negative pressure cavity due to the cleft of the upper lip and palate, which makes it difficult to complete the sucking action; in addition, the distribution and attachment of the muscles of the lip and palate change, making the development and tension of the muscles insufficient, causing the tongue to retract; at the same time, the tongue is overdeveloped, and the tongue is not raised to effectively wrap the pacifier when sucking; and the soft palate is shortened or cannot be raised to the imperfect function of the soft palate, which affects sucking and swallowing, resulting in Feeding quality is not high.
We can improve feeding through the following methods.
1.Change the position.
(1) take a sitting position or 45b angle holding position, do not lie flat, so as not to choke and cough;
(2) use face-to-face feeding to facilitate observation.
(3) use the prone position, so that the nasal cavity above the mouth without choking and coughing.
2.Use appropriate feeding apparatus: spoon, dropper, squeezable bottle or plastic bottle with cross opening.
3.How long do I need to be hospitalized after surgery and how should parents take care of it?
You can be discharged from the hospital in about 3 days after cleft lip repair and 5 days after cleft palate repair.
After cleft lip surgery, parents need to use spoon feeding and avoid bottle or breast feeding because the sucking of the child can cause excessive local tension in the wound, resulting in poor wound healing and obvious scarring. In addition, the wound is painful after surgery and the child is reluctant to suck on the pacifier, resulting in insufficient food intake.
Postoperative attention should be paid to.
(1) Do not feed too hot food.
(2) A small amount of warm water should be taken after feeding to clean the mouth.
(3) Avoid the stimulation of residues and too hard food.
(4) Keep the wound locally clean and dry.
(5) Avoid excessive crying and scratching and collision with the wound site.
(6) Forced braking of the elbow joint is required if necessary.
Children with cleft palate should be fed with liquid food for 2-3 weeks after surgery, and then changed to semi-liquid food, and can be fed with general food after 1 month. It is strictly forbidden for the child to cry loudly or put fingers or playthings into the mouth after surgery to prevent the wound from splitting. To prevent wound infection, the child’s mouth should be cleaned daily and the child should be encouraged to drink more water. Pay close attention to postoperative bleeding.
On the day of surgery, if there is blood in the saliva but no obvious bleeding or bleeding point, no special treatment is needed and hemostatic drugs can be given systemically. When there is blood clot in the mouth, attention should be paid to check the bleeding point. If there is a small amount of bleeding without obvious bleeding point, local compression with gauze should be used to stop the bleeding. If there are obvious bleeding points, sutures should be used to stop the bleeding, and those with large amounts should go back to the operating room for exploration and complete hemostasis.
4.When is it better to operate again after cleft lip surgery for secondary lip and nose deformity?
For children with cleft lip, multiple surgeries are usually needed, so when is the best time to correct the secondary deformity of the lip and nose? As society pays more and more attention to children’s mental health, for those who still have more obvious deformities after the first surgery, it is recommended to undergo surgery again before school age (before 5 years old) to avoid inferiority complex.