Cleft lip and palate – Slit in the mouth
Slit in the mouth, either involving the lip, palate or both.
They cause difficulty for feeding both to the mother as well as the newborn, which can be overcome by using an obturator (feeding plate).
The obturator helps in creating vaccum so that the child can suck the mother’s milk or nipple.
An imprint/scan of the child’s oral cavity is done; following it an obturator is fabricated.
A floss can be secured to the obturator which aids in easy removal of the obturator from the oral cavity.
The obturator is made up of a medical grade plastic which is softer on the inner side and hard on the outer surface.
Initially the child feels discomfort for a short period of time, which later disappears once the child gets used to it.
During feeding the child is to be kept at 45° angle and feeding has to be done.
After every feed the obturator has to be cleaned with a mild soap and water.
Use of long nipple bottles, controlled flow bottles is recommended.
At around 3 months pre surgical naso alveolar molding can be started.
It is a nonsurgical method of reshaping the gums, lip and nostrils before cleft lip and palate surgery, lessening the severity of the cleft.
Three too six months after birth once the molding is complete, a surgery is performed.
This helps in easy molding of the tissues due to presence of hyaluronic acid.
During the Presurgical naso alveolar molding procedure, elastics are secured to the obturator and the tissues are approximated.
Objectives of Presurgical naso alveolar molding
• Causes active molding and repositioning of the deformed nasal cartilages and alveolar processes.
• Increases the length of the columella
• Lip segments are placed in a more anatomically correct position facilitating lip repair without scarring.
• Favors nasal correction.
• Forces exerted on nasal structures while performing alveolar molding permit straightening of columella and correction of alar cartilage displacement. Thereby reducing the number of nasal surgical procedures and improving nasal esthetics.
At around 4 -6 months, the lip surgery can be done.
Palatal repair can be done at around 10 – 12 months.
To perform lip surgery the child should be of 10 weeks, 10 pounds weight and hemoglobin should be 10gms.
The various treatment timings for repair in cleft lip and palate patient include:
|
Timing |
Treatment done |
|
Birth |
Initial Assessment Pre-surgical assessment |
|
3 -6 Months |
Primary Lip repair |
|
9-18 Months |
Palate Repair |
|
2 Years |
Speech assessment |
|
3-5 Years |
Lip Revision Surgery |
|
8-9 Years |
Initial interventional Orthodontics Preparation for alveolar bone grafting |
|
10 Years |
Alveolar Bone Grafts |
|
12-14 Years |
Definite Orthodontics |
|
16 Years |
Nasal Revision Surgery |
|
17-20 Years |
Orthognathic Surgery |
A Multidisciplinary team is required for the repair of Cleft Lip and Palate.
The child should be taken to all these specialists
Genetic Scientist
Pediatrician
Pedodontist
Orthodontist
Oral and Maxillofacial Surgeon
Prosthodontist
ENT Surgeon
Plastic Surgeon
Psychiatrist
Speech Therapist
