INSTITUTE OF PLASTIC AND RECONSTRUCTIVE SURGERY

Swedish Specialist hospital .100 meter street .Erbil Kurdistan-Iraq

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The Anatomy of an Unfinished Masterpiece

 

It's typical to view a cleft condition as something that "went wrong."

However, it's more accurate to view it as something "unfinished."

A cleft results from incomplete joining (fusion) of some embryo body

areas very early in a baby's development. This failure to fuse

typically occurs during the sixth to 11th week of pregnancy.

After a couple of windows of opportunity, those particular

sections of the body have no further chance to fuse. The body

moves on to other development and the area of unfinished fusion

becomes the basis for a cleft.

 


 

 

Statistics reassure us that having a child with a cleft does not mean

you'll have other children with the same condition. In fact, your

chances only increase by 2 to 5 percent compared to couples

with no cleft-affected kids. Variations in the programmed information

packets (genes) that determine a baby's development enable

clefts to occur in either gender and any race. It tends to affect boys more often than girls, and is slightly more common in some races as compared to others. While cleft lip/palate conditions occur alone, we also see them as a subset of other craniofacial (cranio=head/skull; facial=face) syndromes and conditions.

Studies point to external and/or controllable factors that might contribute to the risk of having a child with this condition. Mothers between the ages of 19 and 35 statistically have a lower incidence of conceiving a baby with a cleft, as do moms who practice preventive measures such as taking supplemental folic acid, and eating a healthy diet with adequate vitamins and minerals. Women can take steps to reduce risk by avoiding environmental factors that may contribute to the likelihood of conceiving a baby with a cleft, including: pesticides, cigarettes, lead, and all varieties of drugs (prescription drugs, over-the-counter medications, illegal drugs, anti-convulsant medications, alcohol and any form of nicotine).

You can determine your approximate risk of conceiving a child with a cleft condition by obtaining genetic counseling prior to conception. Genetic counselors are highly educated in understanding how your health and family medical history relate to having a baby with a cleft. It is becoming the norm, rather than the exception, for cleft palate treatment team referral to occur during pregnancy following ultrasound diagnosis, rather than after the child's birth.

Age

Treatment

Rationale

 

Newborn

Orthopedic Appliance

 

  • Minimizes facial distortion

  • Controls palate segments while awaiting palate closure

  • Prevents abnormal tongue placement habit

 

Naso-Alveolar Molding Device

 

  • Encourages more normal feeding patterns

  • Reduces air swallowing during feeding

  • Allows nasal breathing

  • Decreases lip and nose malformation

  • Involves family: direct contribution to baby's daily care

 

 

3 months

Ear and Nasal Repair

 

  • Best if greater than 10lbs, 10 weeks, and/or 10mg/dl hemoglobin

  • Natural-looking closure is top priority

  • Muscle reconstruction is essential

  • Nose catilage reshaping stabilizes lip/nose during growlh

  • Thorough pre-consideration of scar tissue's natural pull

 

 

Ear Tube(s)

 

  • Provides ear ventilation, prevents chronic fluid build-up, infection

 

 

9 – 12 months

Palate Repair

 

  • Repair timed to ensure functional palate by time of speech

  • Early closure critical to promote best speech development

  • Prepare for healing process contraction to pull upper jaw back

  • Single stage closure of hard and soft palate

 

 

Preschool to 5 – 7 years

Palatal Expander

 

  • Palatal expander gently shapes/widens upper jaw arch

  • Creates space for 6-year molars

  • Setup for bone grafting

 

 

Speech Exercises

 

  • Articulation, speech, breathing, and tongue habits learned

 

 

Hearing Evaluations

 

  • Must correct any hearing loss to ensure normal speech/learning progress

 

 

Bone Graft(s) at Cleft Site(s)

 

  • Fills in the cleft area of dental ridge so incoming incisors anchor well; also creates normal maxillary arch shape and width

  • Serves as "mortar" between palatal segments

  • Ensures proper alignment of incoming permanent teeth within arch

  • Closes any remaining holes in the palatal lining or in the nasal floor

  • Improves oral/nasal hygiene

 

 

May Extract Malformed/Extra Teeth May Bracket/Move Rotated Teeth

 

 

7 – 12 years

Orthodontic Treatment

 

  • Rapid growth period: intervention can ellectively influence and assist normal development

 

 

12 years to Final Growth

Lip, Nose, Scar Surgery (if needed)

 

  • Facial shape may have changed significantly throughout childhood; refinement creates pleasing appearance and improves function (breathing, speaking, eating)

 

 

 

Continue/Complete Orthodontics, Jaw Surgery (required 20%-30% of the time)

 

  • When body growth stops, jaw reaches full growth; surgery holds