Cleft lip and palate is a condition that occurs due to a fusion defect of the structures in the facial region during the embryological period. Although it is among the craniofacial problems that can be easily resolved, obtaining acceptable and successful results is quite challenging. The key to achieving successful outcomes lies in having a high level of knowledge and adhering to modern concepts. Cleft lip and palate can occur separately or together, with an incidence rate of approximately 1 in 800-1000 births.
The exact cause of cleft lip and palate is not known, but it can be attributed to genetic factors, environmental factors, the use of certain medications during pregnancy, maternal smoking and alcohol consumption during pregnancy, various infectious diseases, as well as deficiencies in folate and vitamin B. Babies with cleft lip and palate may also have accompanying congenital anomalies.
Cleft lip can range from a small notch in the lip to a bilateral cleft. It can also be accompanied by a cleft in the alveolus, which is the bony structure where the dental arch is formed. Babies with cleft lip can breastfeed normally without encountering significant problems. The main concern in individuals with cleft lip is the cosmetic issue.
Cleft lip repair is performed when the baby is 3 months old. The goal of cleft lip repair is to achieve a cosmetic appearance that is very close to normal. In our clinic, during cleft lip repair, the alveolus is reconstructed by placing bone, which is the most contemporary method practiced in modern plastic surgery clinics abroad. The advantage of early reconstruction of the alveolus is that it results in a better cosmetic appearance of the lip and elevation of the depressed nasal wing on the cleft side. Early repair of these anomalies helps prevent psychological problems that may arise in the child.
Cleft palate can affect either the soft palate or the entire palate. If there is only a cleft in the soft palate, repair can be performed at 3 months of age. If there is a cleft involving the entire palate, repair is done at 9 months of age.
The most significant problem in cleft palate is related to the baby’s feeding. Due to the cleft in the palate, food can enter the Eustachian tube and respiratory tract during feeding, leading to frequent middle ear infections and respiratory tract infections. These infections can negatively impact the baby’s development. Moreover, recurrent middle ear infections can cause permanent hearing loss in infants. Therefore, it is essential for the family to seek professional help regarding the baby’s nutrition.
The main objective of cleft palate repair is to restore the function of the palate muscles and achieve normal physiology, ultimately leading to normal speech. In our clinic, most individuals can achieve normal or near-normal speech. In addition to cleft closure, elongation of the palate plays a crucial role in achieving function that is very close to normal. We employ a different technique for cleft palate repair in our clinic to achieve this goal. In cases of severe clefts, speech problems may persist despite all surgical repair techniques, requiring the assistance of speech therapists.
Late Deformities of Cleft Lip and Palate
Cleft lip and palate repairs are typically performed at 3 and 9 months of age. However, during the developmental period, structural and shape changes occur in the upper jaw and nose. Problems such as nasal asymmetry, asymmetry of the nostrils on the cleft side, and nasal collapse can arise. These issues, and others, are resolved in our clinic before the age of 5, ensuring that the child starts their school years without psychological problems and difficulties.
Since the alveolus and the palate together form a part of the upper jaw, late developmental disorders of the upper jaw can also arise. Some patients may experience a retruded upper jaw, while others may have irregularities in the alveolar arch. Structural problems in the upper jaw can be easily corrected through surgical intervention accompanied by orthodontic treatment around the ages of 14-15. In our clinic, we collaborate with numerous orthodontic specialists to address these issues.