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Cleft Lip

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Cleft Lip

Cleft lip and palate are congenital disorders that arise from a fusion defect in the structures of the lip and palate during fetal development due to various reasons. This condition, commonly known as "harelip," is the second most common congenital anomaly. Among its causes, heredity plays a significant role.

If there is a cleft lip or palate in the mother, father, or siblings, the likelihood of the newborn having this condition starts at 4% and can rise to 18-20% depending on the situation. During the first trimester, when lip and palate development is completed, medications used by the mother during pregnancy and infections she experienced can play a role in the etiology of the cleft. Additionally, some syndromes may be associated with cleft lip and palate.

The incidence is approximately 1 in every 750 live births, with higher frequencies observed in Eastern and Southeastern Asia. Cleft lips can be unilateral or bilateral and are classified as partial or complete based on the severity of the anomaly. Severe deformities in babies with a cleft lip may also lead to significant nasal shape issues.

Children with cleft lip and palate may face aesthetic and functional problems related to feeding, appearance, speech, and middle ear diseases. It is important for these babies to be fed breast milk as much as possible. If breastfeeding is not possible, expressed milk and, if necessary, supplementary formulas should be given in a semi-upright position at frequent intervals. Special bottles can be used for this purpose.

Cleft lips are typically repaired between three to six months of age, while cleft palates are operated on before the child begins to speak, usually before one year of age. For severe complete cleft lips, orthodontic shaping procedures are performed immediately after birth to reduce deformity. Therefore, an orthodontist consultation is important immediately after birth in necessary cases.

Babies with cleft lip and palate may require multiple surgeries from birth to adolescence. These may include:

  • Lip and nasal revision
  • Surgeries if speech is unclear
  • Bone grafting to the alveolar region for proper tooth alignment
  • Jaw surgeries if there are issues with upper jaw development
  • Nasal surgeries after adolescence

In cases of fluid accumulation in the middle ear due to muscle weakness, early surgical intervention by an Ear, Nose, and Throat specialist is crucial. This involves draining fluid or infection from the eardrum and placing a ventilation tube if necessary.

Approximately one-fifth of patients after cleft palate surgery may experience nasal speech or other speech issues, which may require further surgical interventions. Subsequently, speech therapy is necessary.

For patients facing numerous aesthetic and functional challenges, treatment and follow-up should start immediately after birth and continue into adolescence. While Plastic Surgery plays a primary role in their treatment, a multidisciplinary approach involving Ear, Nose, and Throat specialists, Pediatricians, Speech Therapists, and Orthodontists is essential for effective management.