Approximately 1 in 700 children born have a cleft lip or a cleft palate. An older term is harelip, based on the similarity to the cleft in the lip of a hare. Clefts can also affect other parts of the face, such as the eyes, ears, nose, cheeks, and forehead. Most of the craniofacial clefts are even rarer and are frequently described in medical sciences. A cleft lip can be successfully treated with surgery, especially so if conducted soon after birth or in early childhood.
What is Cleft-lip?
A Cleft lip (cheiloschisis) is a variation of a type of clefting congenital deformity caused by abnormal facial development during gestation. A cleft is a fissure or opening or a gap. It is the non-fusion of the body's natural structures that form before birth. During early pregnancy, separate areas of the face develop individually and then join together, including the left and right sides of the roof of the mouth and lips. However, if some parts do not join properly, sections don't meet and the result is a cleft. If the separation occurs in the upper lip, the child is said to have a cleft lip.
What are the Types of Cleft-lip?
The three common kinds of cleft-lip are:
Cleft lip without a cleft palate
Cleft palate without a cleft lip
Cleft lip and cleft palate together
What are the Problems Associated with Cleft-Lip?
Cannot suck effectively
Milk gets into the nasal cavity and may result in choking or aspiration
Increased number of cavities
Malocclusion of teeth - When teeth are bunched together or on top of each other.
May develop nodules on the vocal cord due to vocal abuse
Delayed speech and language development
Difficulty with articulation and proper pronunciation of words
Most children with Cleft Lip are prone to middle ear infection
May be associated with repeated ear infection
To pay the price for looking and sounding different
Suffer isolation and alienation
What is Cleft-lip Surgery? Cleft-lip Surgery (cheiloplasty) is surgical procedure to correct a groove-like defect in the lip. A cleft lip can range in severity from a slight notch in the red part of the upper lip to a complete separation of the lip extending into the nose. Clefts can occur on one or both sides of the upper lip. Surgery is generally done when the child is about 10 weeks old. Muscle function and the normal "cupid's bow" shape of the mouth are restored. The nostril deformity often associated with cleft lip may also be improved at the time of lip repair or in a later surgery.
Why Cleft-lip Surgery?
This type of surgery is done to correct a physical defect caused by a cleft lip or cleft palate. It is important to correct these conditions when they cause problems with nursing, feeding, or speech.
How to Prepare for Cleft-lip Surgery?
Facial clefting has a wide range of clinical presentations, ranging from You will meet with a speech therapist or feeding therapist soon after your child is born. The therapist will help you find the best way to feed your child before the surgery. Your child must gain weight and be healthy before surgery. Your child’s surgeon may:
Test your child’s blood (do a complete blood count and "type and cross" to check your child’s blood type)
Take a complete medical history of your child
Do a complete physical examination of your child
Always tell your child’s doctor the drugs you are giving your child
Include drugs, herbs, and vitamins you bought without a prescription
About 10 days before the surgery, you will be asked to stop giving your child aspirin, ibuprofen (Advil, Motrin), warfarin (Coumadin), and any other drugs that make it hard for your child’s blood to clot.
Ask your child’s doctor the drugs the child should still take on the day of the surgery.
Most times, your child will not be able to drink or eat anything for several hours before the surgery.
Give your child a small sip of water with any drugs your doctor told you to give your child.
Your child’s doctor or nurse will tell you when to arrive for the surgery.
The doctor will make sure your child is healthy before the surgery. If your child is ill, surgery may be delayed.
What is the Procedure for Cleft-lip Surgery? Cleft-lip surgery can be initiated at any age, but optimal results occur when the first operation is performed between two and six months of age. Surgery is usually scheduled during the third month of life. While the patient is under general anesthesia, the anatomical landmarks and incisions are carefully demarcated with methylene blue ink. An Endotracheal tube prevents aspiration of blood. The surgical field is injected with a local anesthetic to provide further numbing and blood vessel constriction (to limit bleeding). Myringotomy (incisions in one or both eardrums) is performed, and Myringotomy tubes are inserted to permit fluid drainage. There are several operative techniques for cleft lip reconstruction. The Millard rotation advancement (R-A) technique is the most widely accepted form of repair. This method involves rotation of the entire philtral dimple (groove in the upper lip) and Cupid's bow (double curve of the upper lip). The scar falls along the new philtral column (central section of the upper lip), and is adjusted as required since the procedure allows for flexibility.
The Millard procedure begins with an incision on the edge of the cleft side of the philtrum, and the cutting continues upward, medially, and to the side. A second incision extends to the buccal sulcus (top part of the upper jaw). The length of this incision depends on the size of the gap to be closed. In this second incision, the surgeon frees soft tissue, which allows him or her to completely lift the lip from the underlying bone. This dissection should be tested to ensure free advancement toward the middle (inadequate dissection is the root cause of poor results). Nasal deformity can be dealt with by a procedure known as the Macomb nasal tip plasty, which elevates the depressed nasal dome and rim. Cartilage from the cleft side is freed from the opposite side, and is positioned and reshaped using nylon sutures. Advantages of the Millard rotation advancement technique include the adaptable and flexible approach with minimal amount of tissue discarded.
What are the Post-Operative Care after Cleft-lip Surgery?
The postoperative focus is on ensuring proper nutrition, as well as lip care and monitoring the activity level. Breast milk or full-strength formula is encouraged immediately after surgery or shortly thereafter. Lip care for patients with sutures should include gentle cleansing of suture lines with cotton swabs and diluted hydrogen peroxide. Liberal application of topical antibiotic ointment several times a day for 10 days is recommended. There will be some scar contracture, redness, and firmness of the area for four to six weeks after surgery. Parents should gently massage the area, and avoid sunlight until the scar heals. The patient's activities may be limited. Some surgeons use elbow immobilizers to minimize the risk of accidental injury to the lip. Immobilizers should be removed several times a day in a supervised setting, allowing the child to move the restricted limb(s). Interaction between the orthodontist and surgeon as part of the treatment team begins in the neonatal period, and continues through the phases of mixed dentition.
How is the Recovery after Cleft-lip Surgery?
Your child may be restless for awhile after surgery, but your doctor can prescribe medication to relieve any discomfort. Elbow restraints may be necessary for a few weeks to prevent your baby from rubbing the stitched area. If dressings have been used, they'll be removed within a day or two, and the stitches will either dissolve or be removed within five days. Your doctor will advise you on how to feed your child during the first few weeks after surgery. It's normal for the surgical scar to appear to get bigger and redder for a few weeks after surgery. This will gradually fade, although the scar will never totally disappear. In many children, however, it's barely noticeable because of the shadows formed by the nose and upper lip.
What are the Benefits of Cleft-lip Surgery? The team approach to correcting Cleft Lip and other problems associated with it has several fold benefits. Symmetry or balance of facial features is restored to a great extent but not completely. The surgeons have mastered sophisticated techniques that have improved the success rate of surgery for Cleft Lip many fold. If the surgery to repair Cleft Lip is performed in the first year of life, chances are that ability to feed properly, talk, facial growth and development of social skills will be less problematic in the years to come.
What are the Risks of Cleft-lip Surgery?
There may be excessive scarring and contraction of the lips. Whereas the lips in most cases remain red in the initial stage but thus the redness and contracture is part of the normal healing process
Why Cleft-lip Surgery in India?
Cleft-lip Surgery in India has come out to be the best option for international patients since most of them desire a budget saving and good medical treatment. The Indian medical centers have team of professional and specialist who have a passion for the science of medical treatment in India and are known for good results.
Cleft-lip Surgery in India comes with advanced cosmetic protocols and is delivered using modern facilities, sterile techniques and products meeting international standards which are designed for comfort and efficiency as evident in developed nations through expert cosmetic care to foreign patients.
Cleft-lip Surgery in India is done at medical centers that are equipped with high end medical amenities. These medical centres adheres all the international benchmark and maintains a high standard as practiced in developed nations of US and UK. The hospitals catering the procedures of Cleft-lip surgery are available in the following Indian cities:
What is the Cost of Cleft-lip Surgery in India?
Cost advantage is a major selling point for Cleft-lip Surgery in India. The cost differential across the board is huge: only a tenth and sometimes even a sixteenth of the cost in the West. Thus this plays a vital role in attracting a sea of foreign patients all across the world to India. The following figure indicates the cost of certain treatments in US and India, which can give you a fair idea of the cost difference.
USA (in USD)
India (in USD)
Some of the common countries from which patients travel to India for surgery are:
Located in South Asia, bordered by Pakistan, Nepal, China and Bangladesh, India is South Asia's largest, sovereign, democratic republic. India has an edge over other countries when it comes to offering comprehensive, cost-effective and timely medical care: it also offers an exotic, adventure-filled or cultural -if you wish array of destinations to discover and revel in for the travelers. Indian cities like Mumbai, Hyderabad, Goa, Bangalore, Nagpur, Kerala, Delhi, Pune, Jaipur, Chennai, Gurgaon, and Chandigarh offers best medical tourism service.
Mumbai - Mumbai, formerly known as Bombay in English, is the capital of the Indian state of Maharashtra. This port city (India's largest and busiest) accounts for a major share of the government's revenue, and has one of the world's largest harbour. There are many things to love about Mumbai. One is simply the geographical names, like The Queen's Necklace and Elephanta Island, all with roots in the British Empire.
Hyderabad - Also known as City of Nizams. The city of Hyderabad has its own individual character, which is evident in the beautiful, ancient palaces and the equally modern, and state-of-the-art offices and buildings. Medical tourism at hospitals in Hyderabad combines care for your health with international tourism. The primary reason
behind its surging popularity is better healthcare services at an affordable budget.
Goa - Popularly known as the ‘Rome of the East’, Goa boost of natural, magnificent churches and exquisite works of man. Plunge into the clear blue water of the large pool, or soak in the blissful sunshine on the picturesque island. Goa is an interesting location for getting your health propped up and getting those long postponed surgeries done. You have modern facilities, short waiting times and very affordable prices for procedures, hospital services and medicines.
Bangalore - The progressive and modern city of Bangalore is the state capital, being located within India's Karnataka state. Bangalore is often referred to as the country 'Garden City', due to its high concentration of parks and green spaces. Bangalore has few of the world’s best doctors and medical practitioners, who have been trained by the rigorous Indian medical education system as well as in countries like UK and USA.
Nagpur - Nagpur City has many distinctions. It is also the second greenest in India and is located at the very center of the heartland, almost equidistant from Kolkata, Chennai and New Delhi and Mumbai. The present city was founded in the early 18th century by Bhakt Buland, a Gond prince of the kingdom of Deogad in the Chhindwara district. The Nagpur District has a varied culture, as well as being in the central part of India, the market in Nagpur is flooded with products from all over India. Nagpur has few of the world’s best doctors and medical practitioners, who have been trained in countries like UK and USA.
Kerala - Natural beauty, clean air and primordial greenery amidst the vast expanse of water and sky, typifies the state of Kerala – better known as God's own country. Kerala is famous for its alternative medical therapies such as Ayurveda, which help to rejuvenate and revitalize the body. The region is also home to India’s only virgin tropical rain forest – the Silent Valley National Park, supporting an overwhelming range of life forms, many of which are highly endangered, and endemic to this part of the planet.
Delhi - "Welcome to The Capital City of India - New Delhi" Delhi is famous as Capital city of India is located in North India. Delhi is truly a symbol of the old and the new; a blend of ancient well preserved monuments and temples along with jam-packed burger joints and up market shopping malls. Delhi has state of the art Hospitals and the best qualified doctors.
Pune - Once referred to as the Oxford of the east, Punecontinues to be a stronghold for academics and culture. An array of factors like availability of efficient and experienced doctors, comparatively low treatment costs, hospital facilities of international standards and many more have made Pune one of the top destinations for medical tourism.
Jaipur - Jaipur is one of the most popular destinations on a tourist's itinerary. The magnificent forts, beautiful havelis and colourful bazaars make Jaipur a popular tourist destination among tourists. Jaipur has pioneered health and medical tourism in India.
Chennai - Chennai is one of the most developed urban centers in the Indian subcontinent. The city forms the capital of Tamil Nadu state and is the fourth largest metropolitan city in India. They have some of the very best hospitals and treatment centers in the world. Each hospital is equipped with state of the art facilities. The technology brought into practice is the very latest, including robotic surgery.
Gurgaon - Located in the National Capital Region, Gurgaon is one of the most rapidly growing cities in Greater Delhi. In the last few years Gurgaon has boomed as the hub of IT and other new-age businesses. Gurgoan is the latest destination for Medical Tourism in India as it is the latest modern upcoming city near Delhi.
Chandigarh - Located near the foothills of Shivalik range of the Himalayas, Chandigarh is one of the most beautiful and happening cities of India. Chandigarh has great potential for Medical tourism as the unpolluted and excellent environs give many opportunities to patients to recover from their illness.
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