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What is a cleft Lip and Palate?
Lips and palates develop form separate parts during the first 3 months of
pregnancy. Normally, the left and right parts of the lip come together or "Fuse" creating a normal lip. The two vertical lines on the normal
upper lip are created when the left and right parts fuse. In a similar way,
the left and right parts of the palate come together to create a normal palate.
A front-to-back line along the roof of the mouth can usually be seen where
the joining has occurred.
A cleft lip is a defect in the lip where the two parts from which the lip
develops have failed to fuse. A cleft palate is a similar defect in the roof
of the mouth where the two parts from which the palate develops have failed
to fuse.
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What are the Craniofacial Anomalies?
Craniofacial anomalies are defects or deformities involving the face and the
skull.
These Anomalies occur when the growth of skull and facial bones is affected
leading to deformation of shape of the head and the face. Long facial clefts
can also occur involving the lip, cheek, eyelids and facial bone leading to
sever facial disfigurement. Some of these anomalies may involve eye or ear
resulting in misshapen or absent organ.
Each anomaly needs to be evaluated individually treated accordingly.
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How to feed Cleft Babies?
There is no best method to feed your baby. It is often necessary to
try several methods before deciding which one is best for you both, mother and
child . Quite often food comes down the nose during feeding. This is nothing
to be too concerned about. Simply wipe it away and continue feeding. Children
with only cleft lip will able to such without much problem. However, children
with cleft palate with have problem with sucking.
However feeding needs patience and efforts from mother and baby. Breast
feeding is best, but majority of baby not able to suck enough. If child not
able to suck, the breast milk should be extracted by the breast pump and
given by bottle or spoon.
Bottle feeding is good if good hygiene and sterility of the bottle and nipple
is ensured. If not, spoon feeding is the good method. ‘Paladai’ is an
alternate gadget which is widely used in certain parts of the country and is
acceptable. Both methods are best used with the baby in a fairly upright
posture, resting on mothers arm. This posture reduces the amount of milk
passing up into the back of the nose. For bottle feeding , enlarging the hole
allows milk to flow more freely and avoids the baby having to work hard. Milk
should flow out of the bottle when it is turned upside down. Alternatively , a
soft squeezy bottle can deliver milk at a rate that matches the ability of the
baby to swallow.
By far the greatest problem with feeding, is wind. Because babies have
difficulty sealing their mouths around the teat, they tend to swallow a lot of
air while feeding. To help reduce this tendency, hold the baby more upright
while feeding and ensure the milk is delivered to the back of the mouth, so it
can be swallowed easily. You will need to burp your baby frequently during the
feed, and most importantly, make sure the baby has no air at the end of the
feed before being put down to sleep.
The feedings should given about every 3 hours to start a pattern. If the
feedings are longer apart than that, the baby may get too hungry, and may not
feed well. The feedings should take anywhere from 20 – 40 minutes. If it takes
longer than this, the baby may be working too hard. Try enlarging the hole.
On an average child needs 2-3 once/pound/day milk.
Other liquid diet, semisolid and solids are started like in a normal baby.
Some solid or liquid food will regurgitate through nose, but this is nothing
to worry about. This will stop after palate repair. Follow the instructions
of the doctors for the postoperative feeding.
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Plan of Treatment
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Age of Child
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What should be done? |
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At birth
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First consultation with the Cleft Care Team.
Assessment of the problem and |
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3 - 5
Months |
Cleft lip repair with nose correction |
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12-18
Months |
Cleft palate repair |
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1 - 2
Years
|
Hearing check-up to rule out middle ear collection to prevent infection |
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2 - 4
Years
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Close watch on the development of speech therapy.
Regular dental check-up with the pediatric dentist. |
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4 - 6
Years
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Surgery for speech improvement which is necessary in
10-15% of children after palate operation |
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6 - 12
Years
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Dental check-up and orthodontic treatment, if
necessary, bone graft for the defect in the alveolus at 9 years. |
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Teenage
years |
Surgery of the jaws if there a gross mal-alignment
and Rhinoplasty to.improve shape of nose if patient demands |
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Adult
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Genetic counseling. |
Will the child be normal after treatment?
The aim of treating children with cleft lip and/or palate is to achieve normal
looking and normal sounding well adjusted individuals. The cleft child is
likely to have the best possible result in achieving this aim if treated by an
organized, well trained multidisciplinary team. When treated at the proper
age, normally they have good results. They will be like normal children except
small scar on lip and will need supervision till adolescence. In addition they
might need appropriate intervention by the Plastic Surgeon, the Dentist, the
ENT surgeon and the Speech Therapist at appropriate intervals according to
individual needs during childhood and adolescence.
How much do the Operations cost?
Normally the cost of these operations would run into several thousand rupees
for each surgery in private ward. However several cleft operations at Sri
Ramachandra cleft & craniofacial center at Chennai are sponsored by a
non profit organization called 'smile train'. Poor patients who cannot afford
surgery can be operated completely free of cost under the smile train project
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