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Cleft Lip:

 

 

Cleft Lip or Hare Lip is a birth defect where the upper lip is split or separated either in the middle, on one side or on both the sides.

What are the types of Cleft Lip?

Cleft Lip can be 1) Unilateral Cleft Lip - On one side of the nose or 2) Bilateral Cleft Lip - On both the sides of the nose. Cleft Lip can either be 1) Complete Cleft Lip - When the split extends right up and into the nose or 2) Incomplete Cleft Lip - When the split in the upper lip does not extend up to the nose.

What are the problems associated with Cleft Lip?

  • Feeding Problems
    • Cannot suck effectively
    • Milk gets into the nasal cavity and may result in choking or aspiration
  • Teething Problems
    • Missing teeth
    • Increased number of cavities
    • Malocclusion of teeth - When teeth are bunched together or on top of each other.
  • Speech Problems
    • Nasal voice
    • May develop nodules on the vocal cord due to vocal abuse
    • Delayed speech and language development
    • Difficulty with articulation and proper pronunciation of words
  • Ear Infections
    • Most children with Cleft Lip are prone to middle ear infection
    • Hearing Loss
    • May be associated with repeated ear infection
  • Psychological Problems
    • To pay the price for looking and sounding different.
    • Social Problems
    • Suffer isolation and alienation

What will my child's 'Health Professionals Team' comprise of?

It is important that several health professionals with different expertise are involved to assess and monitor your child's progress as he/she grows up. The team of Health Professional for surgical correction and rehabilitation of a child with Cleft Lip will include:

  • Pediatrician - May be the first one to examine and diagnose the problem of Cleft Lip and make appropriate referrals
  • Dietician - Provides guidelines on proper feeding during infancy, weight gain and preparation for Cleft Lip surgery
  • Plastic or Reconstructive Surgeon - To perform surgical repair of Cleft Lip
  • Speech Pathologist - To work on the speech and language development of your child
  • Audiologist - To monitor hearing which may be impaired due to middle ear infection
  • Ear, Nose and Throat (Otorhinolaryngologist) specialist - Treats middle ear infections
  • Oral Surgeon - Performs jaw alignment and tooth extractions
  • Dentist and Orthodontist - Repositioning of teeth and designing of prosthetic devices like braces and bridges.
  • Genetic Counselor - Counsels and provides information on genetic background of Cleft Lip.

How do I prepare my child for Cleft Lip operation?

Your child will be hospitalized the night before for pre-operative assessment like blood and urine testing, and may be a chest x-ray. You will be instructed not to feed anything to your child for at least 10 hours before the Cleft Lip operation. Also make sure that your child does not have any viral infections like flu, cough, cold or diarrhea.

What does the procedure for repair of Cleft Lip involve?

The surgery for the repair of Cleft Lip is usually done in the first year of life, preferably around 10 months of age. Cleft Lip repair is performed under general anesthesia. The surgeon will make an incision on both the sides of the cleft up to and into the nose. The dark pink outer portion of the separation, which includes the skin and the muscle, will be pulled down, the skin of the lip will be apposed and stitched together thus closing the gap in your child's lip. The surgery for Cleft Lip is performed as a single procedure, which also closes the nostril deformity. Bilateral Cleft Lip sometimes requires two surgeries. Depending on how extensive the birth defect is, surgery for Cleft Lip can take anywhere from 2 - 3 hours.

What is the recovery period like after Cleft Lip surgery?

Your child will feel some pain and soreness following the Cleft Lip surgery. He / she will be irritable and may require some medication to calm down and relieve the pain and soreness which commonly occurs following the operation to repair Cleft Lip. Your surgeon might prescribe antibiotics to minimize the chances of infection while in the hospital. He / she will provide you with instructions on feeding and general care of the baby during the crucial couple of days after surgery for Cleft Lip. Your child may have to be put in restraints to make sure he / she does not rub the area of the face that has stitches. Your child will be hospitalized for about 4 - 5 days, the stitches need not be opened as they dissolve on it's own after a few days.

What is the outcome of Cleft Lip surgery?

Outcome of Cleft Lip surgery is quite good. Most commonly the defect can be corrected in a single operation, very seldom a second operation is required. If the cleft (gap) is extensive and cannot be closed in one surgery, then the operation is performed in two stages. However, there will be unevenness of the upper lip and a faded but a visible scar will be there that your child will have to live with for the rest of his / her life.

Benefits of surgical repair of Cleft Lip

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.

Risks of surgical repair of Cleft Lip

  • Asymmetry of your child's upper lip - This is a common problem when one side of your mouth and nose do not match the other side. In such a case, a revision surgery is performed to try and match both the sides of the face as closely as possible.
  • Incomplete closure of the cleft - A small hole may be apparent in the upper lip after the operation for Cleft Lip has healed. A second operation may be required to completely repair the Cleft Lip.
  • Infection of the incision site
  • Allergic reaction to anesthesia
  • Bleeding, swelling, bruising and delayed healing - It is normal to have some bruising and oozing of bloody discharge around the mouth and nose which will subside in a week or so.

Alternatives to surgical repair of Cleft Lip

There are none, your child can either live with the defect in the upper lip for the rest of his / her life or undergo the plastic surgery for Cleft Lip during the first year of life.

 

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