Congenital Anomalies of the Face
Cleft Lip and Palate
This congenital anomaly, which is seen with a frequency of 1 in every 1000 live births and therefore more common than it is thought, is one of the diseases whose causes are still unknown. Parents of children born with this anomaly may feel very helpless in the face of this unexpected situation. First of all, it should be stated that both cleft lip (CL) and cleft palate (CP) patients have been successfully treated surgically. The important thing is to ensure the correct nutrition and development of the patient until the time of surgery.
The ideal operation time is 3-6 months for lip oil and 9-18 months for cleft palate. During this period, the patient should be followed closely, nutrition should be done in a healthy way, and any undesirable conditions that may occur should be treated effectively. Today, all lip clefts are operated as soon as the baby is three months old. In very rare cases, if the baby’s weight is below normal, it is useful to wait a few more weeks. It should not be forgotten that the three months passed during the birth and surgery are more of a problem for the family than the baby. That is why in this period, enlightening the family and providing psychological support are at least as important as surgery. The duty of eliminating the feelings of guilt in the family and giving information about the future of the baby has always been placed on the physician. The nutrition of the patient with only cleft lip is not a very special problem and it is sufficient to recommend that he be fed with normal methods. Special care is required in patients with cleft palate as the situation is more complex.
A. The first part is the feeding position. Aspiration-related bronchopneumonia is the most common complication in infants fed in the supine position, since the oral and nasal cavities are opened directly to each other in these patients and the palate does not have the function of covering the larynx and opening the pharynx during swallowing. In this regard, feeding the baby in a sitting position is the simplest and easiest method to prevent milk from escaping into the larynx. There is absolutely no need for a special feeding device for these babies in the preoperative period, they can be fed with a bottle like normal babies.
B. The second part is about the feeding process and frequency of the baby. Although this issue is not as vital as the first point, it should be explained because it is a certain factor that prepares the patient for surgery. These babies need to be fed very often to bring them back to their normal (ideal) weight; because the baby cannot get enough milk due to two reasons which we will explain below:
Since the oral and nasal cavities are in continuity with each other, the intra-oral vacuum required for the suction function cannot be created and there is a continuous air leak.
When the absence of the orbicularis oris muscle is added to the cases with cleft lip, the baby cannot fully contract and suck his lips. As a result, he is more tired than a normal baby, but sucks less milk. For this reason, it is necessary to feed these babies patiently and very often.
Babies with these congenital anomalies, who are fed frequently and in a sitting position as stated above, should have no difference from normal babies in terms of weight gain and growth. The high mortality rate in this type of infant is directly related to careless feeding and unintentional feeding disorders, and unfortunately, rarely, insufficient information given by the physician.
Normal families have a 0% chance of having a child with CL/P. If the first child has CL/P, the chance increases 40 times to 4% for the second child and 10% for the third child. If either parent has CL/P, the risk for the first child is 7%, this is when it occurs, it is 17% for the second child.
The multiplicity of cleft lip-palate surgical techniques proves that there is no adequate technique that can solve both functional and aesthetic problems. The main purpose of surgical treatment can be summarized as trying to normalize the lip and palate structures functionally and aesthetically.