What is Cleft Lip and Cleft Palate Repair Surgery?
BDS (Bachelor of Dental Surgery), 10 years of experience
What is the meaning of Cleft Lip and Cleft Palate Repair Surgery?
The surgical procedures that are done to repair the congenital (present at birth) conditions called cleft lip and cleft palate are known as cleft lip and cleft palate repair surgeries. A cleft lip is a split or opening in the upper lip, whereas a cleft palate is a split or opening in the roof of the mouth (known as palate). A cleft lip and cleft palate condition are sometimes seen together.
A cleft lip and cleft palate occur when the facial structures that are developing in the unborn baby do not close completely. Cleft lip and cleft palate are commonly seen birth defects. They can occur as isolated birth defects, or in association with other inherited genetic syndromes or conditions.
In most babies having a cleft lip and/or cleft palate, a series of surgeries can help in restoring the normal function and achieving a normal appearance with minimum scarring. In this article, we will be discussing in detail about cleft lip and cleft palate repair surgery.
- What are the causes of Cleft Lip and Cleft Palate?
- What are the risk factors for Cleft Lip and Cleft Palate?
- What are the symptoms of Cleft Lip and Cleft Palate?
- What is the purpose of Cleft Lip and Cleft Palate Repair Surgery?
- What is the diagnostic procedure before Cleft Lip and Cleft Palate Repair Surgery?
- How to prepare for Cleft Lip and Cleft Palate Repair Surgery?
- What is the procedure of Cleft Lip and Cleft Palate Repair Surgery?
- How to care after Cleft Lip and Cleft Palate Repair Surgery?
- What are the risks of Cleft Lip and Cleft Palate Repair Surgery?
- How to prevent Cleft Lip and Cleft Palate?
- What is the cost of Cleft Lip and Cleft Palate Repair Surgery in India?
What are the causes of Cleft Lip and Cleft Palate?
- Cleft lip and cleft palate occur when the tissues in the baby’s mouth and face do not fuse properly.
- In normal conditions, the tissues that make up the palate and lip fuse together in the second and third months of pregnancy.
- But, in the case of babies with cleft lip and cleft palate, the fusion occurs only partially or does not occur at all leaving behind a cleft or opening.
- Most cases of cleft lip and cleft palate occur due to an interaction of environmental and genetic factors.
- In many cases, a definitive cause is not known.
- The mother or father can pass down a gene that may be responsible for increasing the likelihood of a cleft lip and cleft palate, and an environmental trigger can then cause the condition.
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What are the risk factors for Cleft Lip and Cleft Palate?
Certain factors increase the risk of a baby developing cleft lip and cleft palate. These factors include:
- Family history of cleft lip and cleft palate
- Smoking during pregnancy
- Consumption of alcohol during pregnancy
- Consumption of certain medications during pregnancy, like anti-seizure medications, medications for acne treatment, drugs used for the treatment of cancer and arthritis (inflammation of the joints)
- Diabetic mother
- Vitamin deficiency during pregnancy
- Substance abuse during pregnancy
- Obesity during pregnancy
- Cleft lip with or without cleft palate is more common in male babies
- Cleft palate without cleft lip is more common in female babies
- Commonly seen in the Native Americans
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What are the symptoms of Cleft Lip and Cleft Palate?
The symptoms of cleft lip and cleft palate may include:
- A cleft (split) in the upper lip and roof of the mouth that may affect one or both sides of the face
- A split in the upper lip, that may appear as a small notch in the lip or extend from the lip through the upper gum and floor of the mouth into the bottom of the nose
- A split in the roof of the mouth that does not affect the facial appearance of the baby
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What is the purpose of Cleft Lip and Cleft Palate Repair Surgery?
Cleft lip and cleft palate repair surgery are used to correct the following that may occur due to a cleft lip and cleft palate:
- Feeding and sucking difficulties
- Loss of hearing
- Ear infections
- Dental problems like more number of dental cavities; gum defects; extra, missing, displaced, or malformed teeth
- Difficulties in speech
- Emotional and social problems due to altered facial appearance
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What is the diagnostic procedure before Cleft Lip and Cleft Palate Repair Surgery?
- Physical examination: Most cases of cleft lip and cleft palate can be noticed physically tight after birth.
- Ultrasound before birth: A prenatal (before birth) ultrasound uses sound waves to create images of the developing fetus. A cleft lip may be diagnosed by an ultrasound after the 13th week of pregnancy, although a cleft palate may be more difficult to notice with ultrasound. If the ultrasound shows the presence of a cleft, the doctor may take a sample of amniotic fluid from the uterus (amniocentesis) to check for the presence of any genetic syndromes that may be causing the birth defects.
- Blood tests: The doctor may recommend routine blood tests before the procedure, to check for any underlying medical conditions.
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How to prepare for Cleft Lip and Cleft Palate Repair Surgery?
- The child’s medical history, including the current health status of the child, recent illnesses, past surgeries, allergies, medications, immunizations are noted.
- Inform the doctor if the child has been exposed to any contagious diseases like flu, corona, or chickenpox in the last one month.
- Inform the doctor if the child’s vaccinations are not up to date.
- Inform the doctor of any medications or supplements the child may be currently taking.
- The child may have formula milk for up to 6 hours and breast milk up to 4 hours before the surgery. All other semi-liquids, liquids, and solid foods should be stopped 8 hours before the surgery.
- The child may have clear liquids like water, apple juice, Pedialyte, white grape juice up to 2 hours prior to the surgery. Clear liquids are fluids through which you can see through and have no food bits or pulp in them.
- If the child is taking any prescription medications, ask your doctor whether or not to continue with those medicines before the surgery.
- It is recommended to stop giving your child any blood-thinning medications like aspirin, and warfarin a few days before the surgery.
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What is the procedure of Cleft Lip and Cleft Palate Repair Surgery?
- The surgery for cleft lip and cleft palate is performed in the following order:
- Cleft lip repair: when the baby is three to six months old
- Cleft palate repair: before the baby is one year old
- Follow-up surgeries: between the age of 2 and late teenage years
- The surgery is done in a hospital under general anesthesia (the patient is put to sleep during the procedure).
- The surgical procedure is performed in the following ways:
Cleft lip repair surgery:
- The surgeon makes incisions (cuts) on both sides of the cleft to create flaps of tissue.
- These flaps are then stitched (sutured) together, including the muscles of the lip.
- The repair helps in creating a more normal lip appearance, function, and structure.
- If any initial nasal repair is required, it is usually done at the same time.
Cleft palate repair surgery:
- Many procedures may be done for closing the separation and rebuilding the roof of the mouth (the hard and soft palate).
- The surgeon makes incisions on both sides of the cleft.
- The tissues and muscles are repositioned.
- The repair is then sutured closed.
Ear tube surgery:
- In cases of cleft palate, ear tubes may be placed surgically to reduce the chances of chronic (long-term) ear fluid accumulation, which may cause loss of hearing.
- The ear tube surgery involves the placement of small bobby-shaped tubes in the eardrum.
- This creates an opening for the prevention of fluid buildup.
Surgery for the reconstruction of the overall appearance:
- Additional surgeries may be required later for improving the appearance of the lip, mouth, and nose.
The following additional treatments are recommended after the repair surgeries:
- Speech therapy, for the correction of difficulty in speaking
- Feeding strategies, like using a special feeder or bottle nipple
- Orthodontic (dental braces) treatment, for correcting the teeth positions and bite
- Regular monitoring by a pediatric dentist, ensuring proper oral hygiene and tooth development
- Treatment for ear infections, including the ear tubes
- Hearing aids for a child having loss of hearing
- Therapy with a psychologist to help the child in dealing with the mental stress of undergoing repeated medical procedures
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How to care about Cleft Lip and Cleft Palate Repair Surgery?
- The child will most likely be in the hospital for 5 to 7 days after the surgery.
- The surgical wound needs to be kept very clean. One should not apply any pressure to the wound or stretch it for 3 to 4 weeks after the surgery.
- The wound should be cleaned using soap and water or a special cleaning liquid and kept moist using an ointment recommended by the doctor.
- The child is kept on a liquid diet till the wound heals.
- The child should put any toys or his/her hands in the mouth during the healing period.
- A child may be given splints or arm cuffs to prevent the child from picking at the wound.
- It is normal to have some pain after the surgery.
- The doctor will prescribe some medications for pain, and an antibiotic to prevent infections.
- There may be some blood in the saliva or mucus for a few days after the surgery.
- More clear drainage than normal may come out from the nose for many weeks after the surgery. This happens because the opening between the mouth and nose is now closed. Before the surgery, the drainage of the mucous was directly in the mouth.
- The child may sound congested and snore for several weeks after the surgery. This will go away once the swelling reduces and there is less drainage.
- It is normal for the child to experience sleep disturbances after the surgery. This may happen for a couple of weeks.
- The child may have a loss of appetite after the surgery. It is important that the child drinks enough fluids to stay hydrated.
- Complete healing may take about 4 weeks.
What are the risks of Cleft Lip and Cleft Palate Repair Surgery?
The risks of cleft lip and cleft palate surgery are:
- Bleeding
- Infection
- Need for further surgery
- Breathing problems
- Anesthesia risks
- Damage to the nearby blood vessels, nerves, and muscles (temporary or permanent)
- Poor healing of incisions
- Asymmetries and irregularities in the nose or lip
- Improper healing of the scars, including widening or elevation of the scars
- The bones in the middle of the face may not grow properly
- The connection between the nose and mouth may not be normal
- Fever
- Persistent pain and discomfort
- Dehydration
Contact your doctor if you notice any of the above complications.
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How to prevent Cleft Lip and Cleft Palate?
Although many cases of cleft lip and cleft palate cannot be prevented, these steps may lower the risk of developing the condition:
- One may opt for genetic counseling before getting pregnant, in case of a family history of cleft lip and cleft palate. The genetic counselor will determine your risk of having children with cleft lip and cleft palate
- Take prenatal vitamins during pregnancy
- Avoid smoking and alcohol consumption during pregnancy
- Maintain a healthy weight throughout your pregnancy
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What is the cost of Cleft Lip and Cleft Palate Repair Surgery in India?
The total cost of cleft lip and cleft palate repair surgery in India can range from around INR 1,50,000 to INR 2,25,000. However, many prominent hospital doctors in India specialize in cleft lip and cleft palate repair surgery. But the cost varies across different hospitals.
If you are coming from abroad, apart from the cost of cleft lip and cleft palate repair surgery, there will be an additional cost of living in a hotel and the cost of local travel. After surgery, the patient is kept for two days in the hospital and seven days in the hotel for recovery. So, total cost of cleft lip and cleft palate repair surgery in India comes to a total of INR 1,90,000 to INR 3,00,000.
We hope that we could answer all your questions regarding Cleft lip and Cleft palate repair surgery through this article.
If you need more information related to cleft lip and cleft palate surgery, then you can contact a Plastic Surgeon.
We only aim to provide you with information through this article. We do not recommend any medicine or treatment. Only a doctor can give you the best advice and correct treatment plan.
