Cleft lip and Palate Repair: Indications and Complications

Cleft lip and cleft palate are amongst the most common birth defects. A cleft lip or/and a cleft palate develops when these structures, while developing in the baby, do not fuse. A cleft lip is seen as a slit in the upper lip of a child, while a cleft palate is due to a slit in the roof of the mouth. Cleft lip and cleft palate can also occur together. Some babies are born with a defect only in the muscles in the roof of the mouth and may become symptomatic a few months or years after birth. Cleft lip and cleft palate lead to

• impaired speech,
• difficulty in swallowing,
• higher risk of ear infection and hearing loss,
• impaired tooth development if the cleft extends into the upper gum.

Surgery is indicated for all children with cleft lip or cleft palate unless contraindicated. The aim of the surgery is to restore normal speech, growth and dental occlusion. The repair occurs in many steps.

Cleft lip and palate repair procedure

The surgery for repair of cleft lip and cleft palate is done under general anaesthesia. Your doctor will help you decide the type of general anaesthesia best suited for your child. The stages and procedure for the repair are as follow

• Cleft lip repair: done within first 3-6 month of life; the surgeon makes and incision on both sides of the cleft to create flaps. These flaps are there sutured together to result in a continuous lip surface. Nasal repair, if required is also done during this time.
• Cleft palate repair: performed by the time the child reaches the age of 1 year; there are multiple types of surgeries for the repair of palate, the type chosen by the surgeon will depend upon the type of distortion of the palate. To reconstruct the roof of the mouth, incisions are made to create flaps which are sutured together to result in a continuous surface.

For children with cleft palate and ear tube is placed to reduce the chronic build-up of fluid in the ear and reduce the risk of hearing loss.

Indications for cleft lip and palate repair

Cleft lip and cleft palate surgery is recommended for all children with this condition unless contraindicated.

Complications of cleft lip and palate repair

Cleft lip and palate repair surgeries are performed with utmost care and have a low incidence on complications. Your provider will discuss the risks and benefits of opting for the surgery for your baby. The complications are:

• Bleeding
• Infection
• Irregular healing and scarring
• Damage to nerves
• Damage to blood vessel
• Oronasal fistula formation
• Respiratory obstruction.

Recovery from cleft lip and palate repair

On completion of surgery your child will be continuously monitored as the effect of anaesthesia wear off. Your child will be staying overnight in the hospital after the surgery. A liquid diet is started either on the day of the surgery or the day after. If liquid diet is not resumed on the same day fluids are provided via an intra venous line. Hand restrains may be used during the hospital stay to prevent the child from putting their hand in their mouth. A day after the surgery your child will be discharged from the hospital. You will be advised to continue administration of a liquid diet for 2-3 days followed by switch to soft food. It is advisable to keep pacifiers or other objects that the child may into the mouth, away from the child.

Sources

• Cleft palate repair and variations, Karoon Agrawal, doi:  10.4103/0970-0358.57197
• https://www.plasticsurgery.org/reconstructive-procedures/cleft-lip-and-palate-repair/procedure