Treatment protocols vary according to the extent of the deformity. There is no universal agreement on when to operate and what kind of surgery is to be done as a result different institutions follow different regimes. Our treatment is based on most recent concepts and is the most widely accepted treatment protocol as of now.
We prefer to operate these children at the age of 3 months, besides age the child should have normal blood tests and body weight. Both the cleft of lip and nasal deformity are corrected at the same time. Some of these children may need retouch procedures which are best done at least six month later. All patents in our centre are given treatment for scars after the lip surgery. Sometimes these kids are prescribed nasal conformers which are silicone made soft structures which we need to insert into the child’s nose; this is done to help improve the result of nasal correction.
At the age of 5 years children are old enough to interact with one another, some children where the results of cleft lip surgery are not satisfactory may get subjected to ridicule, this is considered detrimental to the child’s psychological development thus its considered crucial to treat this kids for residual problems like nasal deformity or lip deformity if any at or before this age.
Once the child becomes an adult at the age of 18 years he is evaluated again and offered further corrections if required.
We prefer to operate these children at the age of 3 months, besides age the child should have normal blood tests and body weight. Both the cleft of lip and nasal deformity are corrected at the same time. All patents in our centre are given treatment for scars after the lip surgery. Sometimes these kids are prescribed nasal conformers which are silicone made soft structures which we need to insert into the child’s nose; this is done to help improve the result of nasal correction. Some of these children may need retouch procedures which are best done at least six month later
At the age of 5 years children are old enough to interact with one another, some children where the results of cleft lip surgery are not satisfactory may get subjected to ridicule, this is considered detrimental to the child’s psychological development thus its considered crucial to treat this kids for residual problems like nasal deformity at or before this age.
Dental anomalies are best corrected at the age of 8 years when permanent dentition is established by orthodontists. Some children may require bone grafting (taking bone from some other part of body and using it to bridge the bone gap in cleft region) for the gums, which will help the orthodontist to bring teeth into the cleft area.
Once the child becomes an adult at the age of 18 years he is evaluated again and offered further corrections if required.
Soon after birth it is essential to have proper guidance on how to feed these children. (See section on feeding). Surgery is offered at the age of 7 months, subsequently speech is evaluated at the age of 3 years, a small percentage of these patients will have residual speech deformity, and these patients will require further evaluation and may require a second surgery for speech improvement. Speech deformity associated with cleft palate is called VPI or velopharyngeal incompetence and surgery for VPI is called pharyngoplasty. More information on the types of surgeries available in other sections (see section on speech impairment). Speech therapy from a therapist with experience in cleft cases is essential part of the treatment and may be required from time to time.
A small percentage of patients may be left with a small hole after palate surgery, this hole is called palatal fistula. If left untreated fistula will lead to nasal regurgitation (food going into the nose) and speech impairment. Fistulae are best treated six months after the palate repair by another surgery.
Soon after birth it is essential to have proper guidance on how to feed these children (see section on feeding).
These children are best treated by what is called as naso-alveolar moulding or simply as NAM. It’s a technique by which an intraoral appliance is used to bring the gums (alveolus) on the affected side at the same level as the other side and at the same time helps mould the nose into better shape. Children who have had the benefit of NAM have significantly better results after cleft lip surgery as compared to others.
This the age at which we operate the lip, besides age the child should have normal blood tests and body weight. Both the cleft of lip and nasal deformity are corrected at the same time. All patents in our centre are given treatment for scars after the lip surgery. Sometimes these kids are prescribed nasal conformers which are silicone made soft structures which we need to insert into the child’s nose, this is done to help improve the result of nasal correction. Some of these children may need retouch procedures which are best done at least six month later
At seven months these children are offered surgery for palate surgery. Delay in this surgery is associated with nutritional problems and speech impairment.
A small percentage of patients may be left with a small hole after palate surgery, this hole is called palatal fistula. If left untreated fistula will lead to nasal regurgitation (food going into the nose) and speech impairment. Fistulae are best treated six months after the palate repair by another surgery.
At three to three and a half years of age the children are evaluated for speech problems. A small percentage of these patients may require a second palate surgery to improve speech along with speech therapy. It’s important to understand the speech development is intricately linked to age; children who are treated when they are older have fewer chances of developing good speech.
It’s generally accepted that by this age children learn to mix socially with other children and become aware of their deficiencies and may also be a subject of ridicule, thus at this age the plastic surgeon should take a good look at these children and if required preform what are called preschool surgery it make the child look as normal as possible.
By this age permanent dentition has appeared, at this age these children should go for orthodontics. Some of these children will require a simple surgery where in bone is used to make new gums which will help the orthodontist to bring teeth in the cleft region.
By this time growth is complete and it’s time to have a look at final results. Nose corrections, improvement of lip shape are very commonly required. Some children will also require jaw surgery to improve upper jaw position, this jaw surgery is also known as orthognathic surgery
In this situation the central part of the upper jaw (also called as premaxilla) is not attached to the sides, this allows it unhindered growth and it protrudes out. Soon after birth the bones are soft and aggressive strapping helps push premaxilla back into its position. In these situations, especially when child has presented late cleft lip surgery may need to be performed in two stages. Rest of the treatment stays same as for one sided deformity.
M.B.B.S., M.S., MCh. (Plastic Surgery) Senior Consultant Aesthetic & Reconstructive Surgery. ( Omit gen surgery)
