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Cleft lip and/or cleft palate is one of the more common developmental deformities seen in the human newborn. Fortunately advanced surgical techniques are available to correct these deformities. The deformity occurs from a failure of the lips and/or palate to fuse during certain stages of development. The deformity may vary in severity. The child born with a cleft lip and/or cleft palate is generally of normal intelligence, and can anticipate a long and healthy life. If properly treated surgically, the child can achieve an excellent appearance, normal breathing, and good speech. However, depending on the severity of the deformity one can anticipate a number of operations throughout the patient’s lifetime at specific intervals. What causes a cleft lip and cleft palate? There is a certain stage of embryonic development where the primordial anlage (structures), which create the lip and palate, fail to fuse in human development. The human embryo has a number of clefts, but these normally fuse and come together as the embryo/fetus develops. When they fail to fuse a cleft occurs. Some are caused by genetic factors, but most are developmental in origin. A cleft on one side (unilateral) which does not extend up into the nostril and is not associated with a cleft palate can be closed in a single stage; however a complete cleft which involves the nostril and the cleft palate, or a bilateral cleft, may be associated with a protruding segment of the mouth (central pre-maxilla). By converting this to an incomplete cleft one can achieve a better overall result in a second stage. Eventually bone grafting of the defect in the upper jaw (maxilla) will be undertaken at the appropriate age with sufficient bone to provide a matrix for the dental (tooth) roots. Closure of the lip and palate defects is essential for oral continence and good speech. Cleft palate children characteristically have high arched and insufficient palates. The extended closure helps to correct this and prevent secondary operations such as pharyngeal flap. In order to prevent retrusion or collapse of the mid face, the hard palate is closed after there is sufficient dental occlusion to stabilize this region. Careful attention is made for pediatric orthodontia and speech therapy as necessary. Children with cleft lips frequently develop an associated nasal deformity, the so-called “cleft lip nasal deformity”. The cleft lip nasal deformity generally shows as an under projected nose with flaring nostrils. These are corrected by techniques using autogenous cartilage grafts. Operations on the nose are timed according to age and appropriateness. | ||||