Long before the child is born, in the first weeks of development, the left and right edges of the lip and the palate fuse together after they have developed separately. However, in approximately one out of every 1000 babies, normal union does not occur and the lip and palate remain cleft.
Cleft lip can vary widely, from a small split in the upper lip to a complete cleft that extends to the base of the nose. The cleft can be unilateral or on both sides of the lip. Many children with a cleft lip also have a cleft palate. The problems of the baby in this situation are much more than babies with only cleft lip. In addition, cleft lip may accompany other congenital diseases and problems related to these diseases may be faced.
Surgery for cleft lip is usually performed until the child is 3 months old. Although parents want the cleft to be repaired soon after birth and before the child goes home, neonatal surgery is difficult, as it is dangerous and the results are usually below average. For this reason, many cleft palate and cleft lip treatment centers prefer to wait until the child is about 3 months old to perform the first lip repair. There are many reasons for this delay. First, when the child reaches 10-12 kilos, he/she will be healthier and stronger, and will be less affected by anesthesia and surgery. Second, this waiting interval gives sufficient time to diagnose the extent of the disease and the characteristics of the problem and to plan for the presence of other associated problems, as well as for emergency and long-term treatment. Third, a 3-month-old child is much larger than a newborn in terms of meeting the technical requirements of surgery and is suitable for better results in terms of aesthetic and functional results.
To repair the cleft lip, muscle repair will be performed following an incision on both sides of the cleft. In addition, if it is necessary to take bone or tissue from another place, it may be necessary to make an incision from another place. The cleft will be closed by repairing the oral mucosa and skin. In this way, the muscle will be able to function and the normal lip shape will be formed. The deformity of the nose will also benefit from this intervention.
The surgical scar will become redder and wider in the first few weeks. This appearance will decrease over time, but the scar will never completely disappear. In some children, this scar may turn into a barely visible shape due to shading in the nose and lip area.
Cleft palate is in the form of a small notch that affects the uvula in some children, while in others it extends from the uvula to the lip area. Cleft palate repair can be performed between 3 and 12 months, depending on the condition of the surgeon, anesthesiologist and patient. In this way, it becomes easier for the child to withstand the surgical procedure. During the surgical repair, with the incisions made on both sides of the cleft, the tissues on the margin are brought closer to the midline and the integrity of the palate is ensured. During this repair, the soft palate muscles are also repaired, thus providing the necessary ground for the correct speech and nutrition of the child. In addition, if it is necessary to take bone or tissue from another place, it may be necessary to make an incision from another body part.
It takes several months for the palate to reshape. However, during the repair, the baby's fingers or food utensils (fork, spoon, straw) may damage the palate during the 3 weeks of repair. The insertion of fingers or anything into the mouth should be avoided during the initial stage of healing.