Treatment Plan
If you are thinking that every newborn will be receiving the surgery or the therapy at the same time, and following a similar treatment plan for the cleft palate and lip, you are mistaken. Because the treatment strategies are typically or we can say totally dependent on the child’s needs. Every cleft deformity comes with unique features, manifestations, and health consequences. That’s why the exact treatment pathway will differ. Certain factors will decide what level of treatment and at what time the treatment will be received, for instance, speech problems, dental issues, auditory infections, and nutrition status.
A typical care plan timetable
Like we have mentioned earlier, every situation is different that makes the pediatrician follow the specially tailored treatment plan. But, let us go through a typical plan that is performed for treating cleft lip and palate.
Birth to 6 months aid
From the day the child is born up to 6 weeks of birth, all-day feeding assistance is provided. The hearing tests along with all other physical and visual pediatric assessments are performed regularly.
Cleft lip repair surgery
In the period of 3 to 6 months, cleft lip repair surgery is performed. The surgery is conducted under general anesthesia. The lip gap is closed and the opening is stitched up. Typically, the procedure is done within 1-2 hrs.
The child may necessitate more than one surgery for cleft repair. It relies on the extent of the cleft lip, whether it is complete, incomplete, narrow, or wide. If a second surgery is found to be necessary, it is usually performed after the completion of 6 months of age. Cleft lip repair age is more important to consider.
Palate repair surgery
Typically performed after 6 months of age, but before the baby turns one. Palate repair surgery is done after lip repair to make a satisfying closure of the gap observed in the mouth’s roof. The aim will be to realign the muscles and the lining of the palate. The stitches used for the wounds are usually dissolvable. It will not last for more than 2 hours. Similarly, Cleft palate repair age is also imperative to consider.
Insertion of special tubes
Another benefit of the surgery is that it reduces the chance of fluid moving and accumulating inside the middle ear. During palate repairment, specially tailored tubes are inserted inside the eardrum that helps prevent fluid backlog by aiding the drainage. It enhances the patient’s hearing.
Speech assessment and surgery
It needs to be done frequently to evaluate whether the condition is getting better or worsening. Prefer evaluating after 18 months, at 3 years of age, and when the child turns five. Between 4 to 5 years of age, apart from speech, a nasopharyngeal scope is also done. It helps assess the performance of the palate and throat.
Well, in case the child doesn’t get better and speech is delayed, becomes abnormal, and more unclear, surgery is required. It is usually performed with a mutual decision with the speech therapist. It should not be performed before the age of 5.
Bone grafting and palate expander
As soon as the child gets older, bigger surgeries are planned. The bone grafting is done to repair a cleft deformity in the alveolus or gum area at the age of 8 to 12. It is specially designed for children with a complete cleft lip and palate. It is aimed to fill the upper gum line to strengthen the permanent teeth and provide support to the upper jaw.
Well, the treatment doesn’t end here!
As soon as the permanent teeth grow in, if required, the braces are put for realigning the teeth along with a palate expander which helps widen the palate. Palatal expansion is done at 5 to 7 years of age.
Orthodontic treatment phases
The first phase starts from the age of 6 years featuring small-scale operations and lasts till 9 years of age. Followed by Phase II, large surgeries which are more important are performed starting from 14 years of age and lasting till 18. Orthognathic surgery or in simple words the jaw surgery is also a part of 2nd phase.
Final touchup surgery
Considering adolescence or adulthood, the final adjustments for lip and nose reshaping as well as alignment are planned and performed as required.
Surgeries
You would be shocked to see how many types of surgeries can be performed to rectify the cleft lip and palate. Every medical technique has been proved to provide better outcomes if performed appropriately. With the help of the surgeries, the shape of the lip, nose, face, and ears can be modified. In case of having severe cleft lip and palate, follow-up surgeries are demanded a detailed repairment. Surgeries are a laborious yet assured way of improving speech along with facial appearance. Another purpose of the surgeries is to reconstruct the distorted areas. These are, undoubtedly, laborious and expensive surgeries, and that is why you can only rely on expert pediatric neurosurgeons to make the situation effective. Lip and palate reconstruction is one of the steps that hold the greatest power and need skills. The minimally invasive procedures decrease the need for blood transfusions and post-surgical complications. The most usual surgeries that are considered minimally or non-invasive include:
- A lip-taping regimen performed to slim down the lip or nasal gap
- A nasal elevator helps to correct the shape of the nose
- A nasal-alveolar molding (NAM) is done through a device assisting in realigning the lip tissues into an appropriate position. It is done before lip repair surgery to prepare the lips. It must be done within the time of 1 week to 3 months of age.
The downsides of the surgery
As everything comes with cons along with pros, so does surgeries. Here are the most frequently faced problems:
- Bleeding
- Post-surgical infection
- Poor healing
- Widening of scars
- Temporary or permanent nerve damage
Final verdict
If you want your child to move effectively in society and work confidently, communicate freely and look better, you might need to plan the surgery. Surgeries have the benefit to improve the child’s facial appearance, lifestyle, eating and hearing abilities, breathing and talking style.