How the defect is formed and what forms it has
The fetal face is made up of individual processes that fuse together in the first trimester of pregnancy. If the fusion is disrupted, a gap remains. The upper lip and alveolar process are formed earlier, the palate a little later, so different combinations are possible. An isolated cleft lip can be unilateral or bilateral, complete, reaching to the nose, or partial in the form of a notch. A cleft palate can affect only the soft palate, or it can spread to the hard palate. There is also a hidden form, when the mucous membrane is intact, but the muscles under it are not closed - it is often noticed only by nasal speech.
- Cleft lip only, unilateral or bilateral
- Cleft palate only
- Combined cleft lip, alveolar ridge and palate
- Full and incomplete forms
- Submucosal (hidden) cleft palate
- Isolated defect or part of a genetic syndrome
Causes and risk factors
In most cases, cleft occurs due to a combination of hereditary predisposition and external influences in early pregnancy. It is usually not possible to find a specific culprit, and this is not the parents’ fault. There are known factors that increase the likelihood of a defect, and some of them are controllable: quitting smoking and alcohol, taking folic acid when planning pregnancy, discussing with your doctor all medications you are taking. Sometimes a cleft is part of a genetic syndrome, and then consultation with a geneticist is required.
- Familial cases of cleft
- Smoking and alcohol in the first trimester
- Folic acid deficiency
- Taking certain anticonvulsants and other drugs
- Poorly controlled maternal diabetes mellitus
- Some genetic syndromes
Feeding the baby before surgery
The main task of the first weeks is to ensure weight gain, because the child must approach the operation healthy and strong. With a cleft lip, breastfeeding is often possible; with a cleft palate, the child cannot create a vacuum in the mouth, and he needs special bottles and nipples. Feed in a semi-upright position, in small portions, more often than usual, with pauses for belching air. Expressed breast milk remains the preferred diet. The specific method is selected by a pediatrician and a feeding specialist, focusing on weight gain.
- Semi-vertical feeding position
- Special nipples and bottles for cleft palate
- Frequent small feedings
- Pauses for air to pass
- Weight gain control
- Expressed breast milk if it is impossible to put it to the breast
Stages of surgical treatment
Treatment is prescribed by age, and the exact timing is determined by the surgeon based on the form of the defect and the condition of the child. First, the lip is closed, then the palate - this is important for speech, so they try to perform the operation before the active formation of sounds. Later, bone grafting of the alveolar process may be required to ensure that permanent teeth erupt correctly, and in adolescence, correction of the nose and lips and, if necessary, intervention on the jaws. Between operations, the child is seen by an orthodontist and a speech therapist.
- Lip surgery in the first months of life
- Palate plastic surgery in the first or second year
- Bone grafting of the alveolar process at school age
- Correction of the nose and lips in adolescence
- Orthognathic surgery for severe malocclusion
- The exact timing is determined by the operating surgeon.
Speech, hearing and teeth: observation after operations
The operation closes the defect, but does not solve all problems automatically. In children with a cleft palate, the functioning of the auditory tube is impaired, so otitis media and hearing loss often occur - this is monitored by an otolaryngologist. Speech may remain nasal if the soft palate does not close completely; A speech therapist helps here, and sometimes additional surgery is required. Teeth often erupt out of place and there are extra or missing teeth, so orthodontic treatment takes years. Regular sanitation of the oral cavity is mandatory.
- Regular hearing tests and examination by an otolaryngologist
- Classes with a speech therapist from an early age
- Orthodontic treatment and control of teething
- Careful hygiene and caries treatment
- Psychological support for the child and family
- Scheduled inspections by a team of specialists until the end of growth