CLEFT PALATE-CLEFT LIP

Cleft lip can ben vary from a little notch on an upper lip to complete cleft on a nose base. Cleft can be one sided as well as spread both sides of the lip. Many children who have cleft lip also have cleft palate. Problems of the baby that experienced stated situation are differ from the babies who have just cleft lip. Besides, cleft lip can be go with other congenital diseases and these diseases can be encounter a problem.

Cleft lip surgical intervention generally carried out until the child became three-month. There are many reasons of this delay. First of all, when the child reached the weight of 10-12 kg, also became more healthy and strong, thereby, influenced less when it comes to anesthesia and surgery. Secondly, this waiting range gives enough time to diagnose the disease, problems’ features and related other problems’ existence as well as to planning treatment in the long term and the urgent. Thirdly, three month child is more esthetics and functional with regards to meeting surgery’s technical requirements when compared with a newborn baby.

In order to repair cleft lip, following the cut which on both cheeks repair the muscle. Besides, if needed to take bone or tissue from another area, it probably required to cut another area. The cut is covered afterwards buccal mucosa and skin repair. In this manner, muscle functioning and normal lip shape is formed. Malformation on the nose is also take the advantage of this initiative.

After cleft palate surgery, your child may have uneasy period. In order to overcome this process, the required medicines going to bee suggested by the doctor. It is necessary to using bandages which prevent hold your child’s hands far from the surgery area. Within the weeks after take out stitches, you should apply plaster on cut line. At least three months after the surgery, you should massage the scar on the lip 3-5 times a day about 5-10 minutes. This prevents getting knotted under the skin and stop scar to pull lip up.

Surgery scar becoming more red and wide within first weeks. This appearance go down in time but the scar is never going to be disappear.  Shading on nose and lip area on some children, the scar is barely in sight.

Cleft palates are in the shape of little cut which effect the uvula on some children, some of them from uvula to lip area. Cleft palate repair can be made within 3-12 months according to situation of surgeon, anesthesia and patient. In this manner, children can bear up to surgery. During the surgical repair, with the cuts applied the two sides of the cheeks, the tissues from the sides approached into midline and provide unity of palate. During this repairing, soft palate muscles also get repaired and provide a basis for talking and nourishing of your children. Besides, if needed to take bone or tissue from another area, it probably required to cut another area.

Afterwards the cleft palate surgery, within first two days it can be pain and uneasy problems which may easily controlled with medicines. During this time, oral feeding is started but it wouldn’t be enough, so it may be required vascular access to get required support with liquids.

It is required to wait for a few months to reshape the palate. However, in three weeks, baby’s fingers or fork, spoon, pipet can damage the palate. Thereby, avoid fingers and any material to put in mouth.

Nutrition of you baby required special care after the surgery. You should keep your baby out of breastfeed mandatorily about 2 or 2,5 weeks.

Baby stays in hospital until drink properly and not having a fever. Generally we send your baby home 1-2 days after the surgery. take out stitches is not required because the stitches going to ben melted.

Development of the complication included ear infection, hearing loss, backlash and malalignment that required orthodontics repair. For these reasons, patient follow up should be with otorhinolaryngology, orthodontist, pediatric expert and speech therapy. Sometimes this team included child psychiatrist and social counselor. While the parents highlighting the appearance, the major thing is overcoming the speech disorders. Some children have speech defects afterwards the surgery because of the muscle on the palate works insufficient. Apart from that, hard of hearing,      closing mouth, insufficient tongue movements, backlash, intelligence level and psychological state can be countable. All this reasons should followed by a team according to order of importance. Even though the problems overcome, speech therapy should be carried on for every children who had cleft palate surgery.

PROBABLE RISK FACTORS OF CLEFT PALATE-LIP SURGERY

Every surgical intervention has a certain extent risk and understanding these risks is important. Choosing surgery is based on comparison with the benefits. Side effects not seen on the patient but in order to be sure, you should discuss the risks with your surgeon.

Bleeding: During the surgery or afterwards can be seen and donating blood may be required.

Infection: It is rare to infection in this type of surgery. In the case of developing infection, it may be required antibiotic usage or surgical intervention.

Respiratory problems: Especially after the cleft palate surgery, leakage can be seen in mouth and it is rare but this leakage may be go windpipe and because of swellings it may cause inspiration problems and create life threatening situation. It may required urgent surgical intervention.

Pulmonary complications (adverse outcome): Pulmonary complications can be developed secondary with anesthesia as embolus plug up the vein or partial lung collapse (the part of the lung cannot take the air). In the case of these complications seen, it is required to hospitalize the children and add on therapy. Pulmonary embolism can be life threatening and fatal.

Scar: After the lip repair scars always on. This is within reason. However, sometimes abnormal scars occurred. They may have different colors from the around tissue. It may be required treatment methods that also included surgery.

Dissociation of stitches: Afterward the surgery, stitches in mouth or lip can be dissociated by the reasons of stitches’ tissue quality, strain, baby’s hands moves to dissociate stitches. In such circumstances, secondary surgical intervention may be required.

Fistula development: In the late term surgery, recovery on palate may be not completed. In the following period, there may be vacuolation in sinus and vestibule of mouth and especially liquid nutritions can pass this vacuolation. In the case of fistula development, secondary surgical intervention may be required.

Surgical anesthesia: There are risks of both local anesthesia and general anesthesia. Each kind of surgical anesthesia or sedation (calming the patient without anesthetize) there is a probability of injuring and even death.

Allergy: In rare situations, allergies reported on stitching materials or topical (external) medicines. The more serious systemic allergic reactions occurs by medicines using during the surgery or prescribed ones. Allergic reactions required add on therapy.

SURGICAL OPERATIONS THAT MAY REQUIRED

There are some different circumstances the point in question effect  cleft palate-lip in the long view. The risks are regarding the lip-palate clefts but they are rare. These are more rare when in comparison. It may require surgical intervention or add on therapy when the complications are seen.  There is no certainty in medicine and surgery. Even though the good results have been waited, they never guarantee. Additional surgical operations contains repairing lip and palate and provide  dental continuity, operations on back of palate and throat in order to resolve speech disorder and genioplasty and orthognathic surgery after puberty and rhinoplasty. You should keep in communication with you doctor for timely intervention.