cleft faq

1. Cleft FAQ

2. CONTENTS What is cleft lip and palate? What causes cleft lip and/or palate? How common is cleft lip and/or palate? What is the treatment for cleft lip and/or palate? What other operations may be necessary? What other kinds of problems could my child with cleft lip and/or palate have? Will this happen to children I have in the future? Our Treatment Approach in AIMS Kochi How to Contact us

3. What is cleft lip and palate? Cleft lip (split of the upper lip) and Cleft palate (split of the roof of the mouth) are the most common types of congenital (birth) defects. Because the lip and the palate develop separately, it is possible for the child to have a cleft lip, a cleft palate, or both cleft lip and cleft palate

4. Cleft lip: A cleft lip is a condition that creates an opening in the upper lip between the mouth and nose. It looks as though there is a split in the lip. It can range from a slight notch in the coloured portion of the lip to complete separation in one or both sides of the lip extending up and into the nose. A cleft on one side is called a unilateral cleft lip. If a cleft occurs on both sides it is called a bilateral cleft lip. A cleft in the gum (alveolus)may occur in association with a cleft lip. This may range from a small notch in the gum to a complete division of the gum into separate parts.

5. Cleft palate: A cleft palate occurs when the roof of the mouth has not joined completely. Cleft palates can be unilateral or bilateral. The back of the palate (towards the throat) is called the soft palate and the front (towards the mouth) is known as the hard palate. If you feel the inside of your mouth with your tongue, you will be able to notice the difference between the soft and the hard palate. A cleft palate can range from just an opening at the back of the soft palate to a nearly complete separation of the roof of the mouth (soft and hard palate). Sometimes a baby with a cleft palate may have a small lower jaw (or mandible), and a few babies with this combination may have difficulties with breathing easily. This condition may be called Pierre Robin Sequence.

6. What causes cleft lip and/or palate? . The exact cause of the condition is unknown. The majority of clefts appear to be due to a combination of genetics and environmental factors

7. How common is cleft lip and/or palate? Cleft lip and cleft palate is the commonest congenital anomaly of the craniofacial region One of every 800 newborns is affected by cleft lip and/or cleft palate. There are 32,000 to 35,000 NEW babies born with cleft deformities EVERY YEAR IN INDIA

8. What is the treatment for cleft lip and/or palate? A child born with a cleft frequently requires several different types of services, including surgery, dental/orthodontic care and speech therapy, all of which need to be provided in a coordinated manner over a period of years .(TREATMENT PROTOCOL for cleft lip/palate) A cleft lip is usually surgically repaired at 2–3 months and the palate at 9-18 months. Generally, surgery requires a general anaesthetic and takes 1-2 hours. The surgeon rearranges the skin and muscles of the lip or the tissues of the palate so no skin grafting from other parts of the body is needed. Most babies recover very quickly and will not experience much pain after this operation. Medication is given for any discomfort. The hospital stay is usually one week.

9. What other operations may be necessary? Minor improvements to the lip or nose may sometimes be required.(Secondary lip/palate surgery) It is recommended that any such surgery take place before the child starts school, typically at 4-6 years of age. An alveolar (gum line) bone graft may be necessary at 7-11 years depending on the type of cleft. A few children may require an extra operation(pharyngoplasty) to improve speech by reducing the amount of air escaping through the nose. This is usually performed early in childhood (3-4 years) when necessary. Other surgery(osteotomy /orthognathic surgery) to help the top and bottom jaw meet in the best position may occasionally be necessary. This is carried out when a child has reached his or her full growth at about 15-18 years of age.

10. What other kinds of problems could my child with cleft lip and/or palate have? In addition to the physical characteristics common to clefts, your child may have the following problems: Problems in feeding Dental development — teeth in the area of the cleft may be missing or improperly positioned. Speech difficulties — cleft lip does not usually result in speech problems; however, often children with cleft palates benefit greatly from early speech therapy. Increased frequency of middle ear infections are possible with cleft palate.

11. Will this happen to children I have in the future? Cleft lip, with or without cleft palate, can run in families. However, in most cases the cause is unknown with approximately a 4% chance of a subsequent child being affected. A medical genetics evaluation is available at our centre in AIMS and will provide specific information.

12. Our Treatment Approach in AIMS Kochi In AIMS ,CLEFT LIP AND PALATE CENTRE ,Department of Head and Neck surgery, we offer a comprehensive approach to treating the child that should start as soon as the child is born. Our specialists are available for consultation with the child’s family even before they take their baby home from the hospital. Ongoing care typically includes treatment planning, genetic counseling, feeding consultation, surgery, speech and language therapy and psychology services, if needed. Presurgical orthopaedic devices may be recommended in selected cases to help narrow the cleft prior to repair, as well as to mold the child’s lip and nose. This can result in an improved surgical outcome. Orthopaedic appliances can also improve the child’s sucking and eating abilities while awaiting surgery. Cleft lip and nose repair typically takes place at 3 months of age, with cleft palate closure occurring between 9 and 12 months in anticipation of speech and language development.

13. APPROXIMATE TREATEMENT SEQUENCE Pre surgical orthopaedics Primary lip repair at 3 month Primary palate (palatoplasty)repair at 18 months Speech therapy Secondary lip/palate repair Cleft orthodontics pharyngoplasty Secondary alveolar bone grafting Cleft osteotomy / distraction Cleft rhinoplasty

14. Cleft lip

15. Unilateral cleft Lip

16. Bilateral cleft lip

17. Cleft palate

18. Cleft lip and palate

19. What can surgery do ?

20. Palatoplasty(surgical repair of palate)

21. Alveolar bone grafting

22. Secondary lip repair

23. CLEFT RHINOPLASTY

24. Feeding in cleft palate children Breast feeding Bottle feeding Progression to solid foods