Monday, July 15, 2013

What Does Cleft Lip/Palate Surgery Entail?

Cleft palate surgery or cleft palate repair is highly recommended in the early stages of infancy without which these congenital conditions can adversely affect the child’s health as well as social interaction by way of speech abnormality, impaired hearing and psychological trauma. Certain clefts involving the gum line may require bone grafting and orthodontic care at a later stage.

Cleft lip surgery is usually recommended when the infant is 7 to 14 days old. There are reputable and experienced plastic surgeons that provide cleft palate repair thereby bringing about an improvement in the hearing, breathing, eating and speaking faculties of the child. A normal appearance is brought about.  The first consideration in cleft lip is pre-operative adjustment via nasal alveolar molding or NAM. This procedure serves three objectives: it realigns the cleft segments of the upper jaw, brings the edges of the cleft lip in closer proximity and thereby facilitate more accurate cleft repair and minimal scarring, allows to begin correction of the nasal deformity to bring about a more natural-looking nose. The process is long and complicated. The surgeon would first create a mold of the upper jaw using dental impression material. An acrylic plate is constructed with this mold, and fitted into the baby’s mouth. It is adjusted on a weekly basis in order to guide the growing bone into a more anatomic alignment. Gradually, the lip tissues also become better aligned, improving the lip alignment. Next is nasal correction. A separate stent is placed from the molding plate extending to the nostril. This is also adjusted on a weekly basis to elevate the nasal tip. The lining of the nose is stretched, bringing about a more accurate and aesthetic nasal repair. 

The duration of nasal alveolar molding depends on the child and also on how severe the condition is. If the deformity is severe, then the time taken would be more. Nasal alveolar molding is of great advantage for patients with bilateral cleft lip and palate. It enables lengthening of the near absent columella to almost normal lengths. Long term follow-up is usually offered for making sure that excellent progress is shown by patients.

Scenario Post Surgery

Usually, it is recommended by the surgeons that the child should stay overnight in the hospital. Some pain will be experienced by the child for the first few days after the surgery. Suitable pain medications will be provided to reduce the pain. Some swelling will also be noticed around the lips for a few weeks. The stitches dissolve on their own. However, it is recommended that the child does not rub the stitches or touch the surgery site as infection may be caused and the healing period may be prolonged.

Taking Care after the Surgery

Directions will be given by the plastic surgeon for cleaning the stitches and maintaining cleanliness around the wounds. An ointment may be given for applying on the lip. If the child experiences pain, then pain medications would be prescribed by the doctor. Sometimes, antibiotics may also be given.  Follow-up visit will be often advised by the plastic surgeon within 5 to 7 days. A second visit may be required after a couple of weeks. If bleeding, signs of infection, redness, warmth, pain, fever or vomiting are noticed after the cleft lip surgery, the plastic surgeon should be consulted immediately.

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