Dr. Hisham Burezq, BSc MD FRCSC FAAP
Consultant Plastic & Reconstructive Surgeon
Consultant Pediatric Plastic Surgeon
Canadian Board and fellowship in plastic surgery
It occurs when the facial structures that grow in the fetus are not completely closed. It is considered one of the most common birth defects. It may occur as an isolated case or it can be associated with many conditions such as the cleft lip or inherited genetic syndromes.
Having a child with clefts can be very upsetting for parents, but thankfully it can be corrected at a high success rate. In most children, a series of surgeries can restore the normal function of the palate.
Symptoms:
Usually, the condition is diagnosed immediately at birth. The cleft lip and cleft palate may appear as follows:
- Either a clear split in the palate (with or without a cleft lip) which is easy to diagnose by the preterm infants counselor at birth.
- Or only a split in the palate muscles that is discovered later due to the emergence of its own signs, which include the following:
- Difficulty in breastfeeding.
- Difficulty in swallowing, with the possibility of liquids or food coming out of his nose.
- The child speaks with a nasal voice (nasality) after the age of 2-3 years old.
- Chronic and recurrent ear infections.
Complications:
Children with cleft lip with or without cleft palate face a variety of challenges, depending on the type and severity of the cleft.
- Difficulty in feeding. Feeding is one of the most immediate problems after birth. While most babies with a cleft lip can be breastfed, the cleft palate may make breastfeeding difficult.
- Ear infections and hearing loss. Children with cleft palate are particularly at risk of developing middle ear fluid and hearing loss, especially if the procedure is delayed after the age of one year old.
- Dental problems. If the cleft extends across the upper gums, tooth growth may be affected.
- Speech difficulties. Since the palate is used to form sounds, the development of normal speech may be affected and speech may appear very nasally (Nasality).
- The challenges of coping with the medical condition. Children with clefts may experience social, emotional and behavioral problems due to the differences in appearance and the intensive medical attention pressure.
Before going to the Hospital:
- Visiting the Anesthesiologist a week before the procedure is important to make sure that the child is ready for general anesthesia.
- The child usually hospitalized for 2 days, and in some cases he needs to spend his first night in the ICU; due to the procedure’s site and its relation to breathing.
- The child should refrain from eating for 8 hours before the procedure.
Procedure:
- It takes approximately an hour and a half under general anesthesia.
- The child will be given painkillers.
- How the child should eat after the procedure:
- We start with water and glucose (sugar) in the first two times.
- Afterwards, the child will drink light liquids (interspersed with light) for two days, such as apple and grape juices and milk.
- The child will then be allowed to drink any type of liquids.
- Starting from the fourth day after the procedure, the child will eat soft food and stays away from eating anything solid for a month after the procedure.
After the Procedure
- It is important for the child to sleep on his stomach or on one side for the first two days; in order to get rid of any secretions or blood after the surgery.
- Lifting the child’s head after the procedure using a pillow starting from the second day and for 24-48 hours is useful for relieving the swelling resulting from the procedure.
- Blood comes out of the mouth and nose in the first two days following the procedure, which is expected and not a cause for concern.
- The child may start snoring for a long time.
- It is expected to have additional openings in the palate because of the movements of the tissues. It is expected, however, that these openings will heal completely and spontaneously within 3 weeks.
After performing the procedure…if the child:
- Stops eating and drinking.
- Suffers from a fever.
- Suffers from a severe bleeding from the mouth.
- Clear unpleasant smell from the mouth.
In this case, the child needs to return to the hospital for examination.
Possible Complications from the Procedure:
The procedure’s success rate is high and reaches 80-90%, but like other procedures, this one may result in rare complications, including:
- The need to enter the ICU, and if this occurs, it will be due to swelling in the pharynx and tongue after the procedure, and usually for one day.
- Delayed wound healing. It may be due to the presence of bacteria inside the mouth, which may result in a cleft palate that requires another surgery to be performed 6-12 months after the first procedure.
- The occurrence of bleeding during or after surgery, with an incidence rate not exceeding 0.5%, but for the sake of caution, blood will be prepared for the child before the procedure.
- The need for another procedure at the age of 5-8 years old to treat the nasality in 30% of the children, if they do not respond to the therapy conducted by the Speech and Hearing Specialist.
- General complications related to general anesthesia, which are very rare.
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