LEE. ADVANCED RECONSTRUCTIVE AND COSMETIC SURGERY OF CLEFT LIPS AND PALATE

One of the prevalent head and neck malformations that a baby may have born with is the improper attachment of the upper lip and/or the roof of the mouth that is called cleft lip and cleft palate respectively. The cleft might be developed just in one side of the lip or it can be elongated to the end of the palate in which lip, gum, and palate would be engaged. These deformities happen as a result of genetic or environmental factors in the first trimester of pregnancy. Although these defects can happen solely in infants, they may also correspond with other congenital disorders. The clefts in the lip and/or palate affect the quality of life of newborns not only due to unpleasant appearance but also because of various annoying consequences accompanied with these deformities like difficulties in breathing and drinking milk, also dental, speech and even audition problems. In these situations, families may suffer along with their children. Nonetheless, the good news is these problems are curable.

Who are the members of the health care team for cleft lip/palate?

A group of specialists are involved in the lip and/or palate cleft repair surgery to solve the associated oral and medical problems. Members of this health care team typically include:

• Plastic surgeon to appraise the lip and/or palate and implement essential surgeries on them

• An otolaryngologist (an ear, nose, and throat doctor) to treat hearing problems through assessing the status of involving anatomical parts and consider treatment options

• An oral surgeon to repair the clefts cosmetically and functionally

• An orthodontist to realign and reposition teeth

• A dentist to evaluate the status of dental health and perform required dental care

• A prosthodontist to ameliorate the dental conditions cosmetically and functionally and improve speaking and eating abilities by utilizing dental appliances and artificial teeth

• A speech therapist to help the infant rehabilitating speech skill

• An audiologist (a specialist associated with hearing disorders) to assess and examine the hearing ability

• A nurse coordinator to monitor the infant health status during the treatment period

How do cleft lip and/or palate be treated?

The clefts of the lip and/or palate can be corrected completely by surgery versus pre- and post-surgical considerations in which the infants can achieve the chance to live a normal life afterward with no or little noticeable scars. The goal of the cleft repair surgeries is functional rehabilitation of speech and feeding capacity as well as cosmetic aim to restoring the normal facial state. However, these repair surgeries are complicated due to the adjustment of different anatomical structures. Since the lip and palate cleft are manifested differently in each case, all of the repair surgeries would be challenging owing to the need for applicating unique approaches. The beginning of treatments is in childhood and often lasts until early adulthood.

What are the pre-/post-surgical considerations?

Preliminary preparations mainly applied in those patients having wide clefts and major problems with the aim of approximate correction of the defects and preparing the site to be aligned properly through definite surgical approaches. These procedures are very diverse ranging from some techniques that are recommended to be done by parents to utilizing specific orthopedic devices or even nasal reconstruction surgery. Moreover, post-surgical considerations include proper home care and medical follow-up in cases with complications.

When is the suitable time for surgery?

Appointing the perfect time for surgery is based on the surgeon's decision according to anesthetic risks and the physical condition of the patient. However, operation at the age of 10-12 weeks with specific weight and blood factors state is mostly recommended.

What are the surgical procedures?

The corresponding surgery is done under general anesthesia. To close the gap in the upper lip, the surgeon will first make an incision on both sides of the cleft and create tissue flaps. These flaps are then stitched together. The cleft lip and palate incisions can be repaired with absorbable or removable sutures. The scars of surgery are often in normal contours of lip and nose. Gradually these scars will diminish and the child's ability to grow and function normally will improve. This reconstructive surgery should be designed to give a child a better appearance and structure.

What are the possible complications?

Some of the complications are because of congenital abnormalities and anesthesia that can be avoided through pre-surgical orthopedics by delaying the surgical intervention until the infant reaches a suitable age. Yet, like any other surgical procedures, in the cleft lip and palate repair surgery there might be possible complications:

• Pneumonia

• Otitis media

• Feeding difficulty

• Bleeding (hematoma)

• Infection

• Irregular healing of scars

• Adverse effects of anesthesia.

Allergy to adhesives, suture threads, blood products, topical products, and injectable drugs.

Damage to deeper parts of the body such as nerves, blood vessels, muscles, and lungs may be temporary or permanent

How long should an infant stay in the hospital?

Optimum admission period is 48 hours post-operation.