Cleft lip surgery is a surgical procedure performed to treat cleft lip. Cleft lip is a congenital abnormality that occurs in infants characterized by the presence of a gap in the lips and palate. The gap is formed due to imperfect union between the two sides of the lips and the palate.
Cleft lip surgery can generally be done on infants aged 3-12 months. If the cleft lip that occurs affects the shape of the nose, the doctor who performs the cleft lip surgery will also improve the patient's nose shape. This nose shape repair surgery is known as rhinoplasty. For the purpose of surgery, the doctor can take tissue from other body parts (grafts). Patients with cleft lip can undergo several operations to completely close the cleft.
Indications for Cleft Lip Surgery
Cleft lip surgery is performed on a child if he has a cleft lip, cleft palate, or a combination of the two. Cleft lip and palate are often known by doctors after the birth of the baby at the time of postpartum examination. However, in some cases, cleft lip can be known at the time of pre-labor examination via pregnancy ultrasound, although the cleft palate must still be examined after the baby is born.
This operation must be performed on children with cleft lip because it can interfere with the process of eating, breastfeeding, and talking. In addition, they can also experience hearing loss and ear infections due to a buildup of fluid in the ear. Children with cleft lip and palate are also more prone to tooth decay due to imperfect teeth development.
Warning for Cleft Lip Surgery
So far, there is no known specific condition that causes a child not to have a cleft lip surgery at all. However, in some children who have an allergy to the anesthetic that will be used, cleft lip surgery can still be carried out with special treatment or supervision.
Preparation for Cleft Lip Surgery
Preparations for surgery can begin from the time a child is born and diagnosed with a cleft lip by a doctor. After that, the doctor along with other health workers will plan with the child's parents related stages of treatment. In general, the planned stages of cleft lip treatment stages that the patient will undergo for several years are:
- Age 0-6 weeks. The doctor will provide temporary treatment related to the condition of the child's cleft lip, to alleviate complaints and difficulties that may be experienced. In addition, the doctor will also make sure the child's eating and drinking processes are not interrupted, as well as conducting a hearing test on the child.
- Age 3-6 months. The plastic surgeon will carry out an operation to repair the cleft lip in a child.
- Age 6-12 months. The doctor will carry out an operation to repair the cleft palate on the child.
- 18 months old. The doctor will carry out an examination of the speaking abilities of children who have had cleft lip and palate surgery for the first time.
- 3 years old. The doctor will carry out the examination of the child's speaking ability a second time.
- 5 years old. The doctor will carry out an examination of the child's speaking ability for the third and last time.
- 8-12 years old. The doctor will perform surgery to repair the cleft in the gum by performing a bone graft on the gum area. This is only done if the child also has cleft gums.
- 13-15 years old. The doctor will perform additional treatments and examinations to monitor and improve the condition of the teeth and gums of children who have undergone cleft lip and palate surgery. The doctor will also monitor the growth and development of the child's jawbone to ensure there are no abnormalities.
Before the child reaches a sufficient age to undergo cleft lip surgery, the doctor will ask parents to keep maintaining nutritional intake, so that the child stays healthy until he reaches a reasonable age of surgery. During this period, parents will be assisted by health workers in addition to doctors who aim to train parents to feed children. After being old enough to undergo surgery, the doctor will examine the child's health condition before undergoing surgery. This examination is in the form of a child's general health examination and supporting tests to ascertain the child's condition, for example a blood test.
A few days before surgery, the doctor will ask parents to stop taking drugs that are at risk of bleeding, such as aspirin or ibuprofen. The doctor will also ask for information from parents regarding medicines and supplements that children consume. A few hours before surgery, parents will be asked by a doctor not to feed and drink children. Health workers will also make sure the child is healthy enough to undergo surgery several hours in advance. If the child is not well enough to undergo surgery, the operation can be delayed for several days until the child is well enough.
Cleft Lip Surgery Procedure
Cleft lip surgery is carried out with the child unconscious after being given general anesthesia. When the child is unconscious, the doctor will immediately repair the cleft lip by uniting the two separate lip sides. If the cleft cleft is too wide to sew, the doctor will perform a special procedure using lip adhesives (adhesions) or lip sticks. The lips are then joined using a sewing thread, both with the sewing thread which can be joined to the lips or which cannot be joined. If the child's lips are sewn with a sewing thread that is not fused with the lips, the child will undergo the procedure to remove the sewing thread after fully recovering and the lips are well fused.
Surgery generally will leave a scar on the lip at the bottom of the nose. However, to maintain the child's appearance, the doctor will arrange and make the scar of surgery as natural as possible. The surgical scar will fade on its own as the child grows. If necessary, the doctor will also adjust the shape of the nose to match the shape of the lips that have undergone cleft lip surgery. Cleft lip surgery generally lasts about 2 hours.
Cleft Palate Operation Procedure
Cleft palate surgery is generally done when children are 6-12 months old, both in children who also have cleft lip or who only experience the cleft palate. Children who undergo cleft palate surgery will first be given general anesthesia, so they will not regain consciousness during the surgical procedure. The doctor will then close the cleft cleft in the palate. In addition, the doctor will also adjust the position and shape of the muscles found in the palate. After the position of the muscles is arranged properly, the doctor will then join the cleft palate using a suture that integrates with the palate muscles.
Cleft palate surgery will generally last about 2 hours. This operation will produce scars on the inside of the mouth, and will not be visible from the outside. The sound of children suffering from a cleft palate will usually hum when talking, and sometimes the buzz is still present even though the child has undergone surgery. In addition, in some cases, buzzing sounds only appear a few months after the child has cleft palate surgery.
Additional Operations
As a child grows, the child's lips and face can change. This condition sometimes causes the child to have additional surgery. Examples of additional operations that can be performed are pharyngoplasty to improve the shape of the throat to improve the quality of speech, and cleft gum surgery if there are gaps between the gums that form together with the cleft lip. Cleft gum surgery will involve a bone graft as a material to hold the gums apart.
After Cleft Lip Surgery
After the surgery, the child will be taken to the care room to undergo postoperative recovery. Generally, children will be hospitalized for around 1-3 days or as needed. During hospitalization, children may be accompanied by their parents.
Parents will be given instructions by the doctor to keep the surgical wound clean and avoid infection. In addition, the surgical wound should not be stretched or compressed during the recovery period, which is around 3-4 weeks. To clean the surgical wound, parents can use special soap and smear the wound with an ointment to keep the wound and skin from the operating area from drying out. The child must be guarded so as not to touch and interfere with the surgical suture, so that recovery can take place to the maximum.
During the recovery period, children are only allowed to be given liquid food. If the child's condition is not possible for the mother to breastfeed, the doctor will give a bottle specially designed for children who suffer from cleft lip and palate. Breast milk can be milked and put in a bottle to be given to children. If it is very necessary, the child will be fitted with a special tube on the nose as a substitute for the entry of food through the mouth.
Postoperative recovery of cleft lip and palate generally runs without serious problems or complications. In addition, after completing cleft lip surgery, the child will undergo a hearing examination that can be affected by the postoperative oral condition. This hearing examination can be repeated at certain times a few years after the operation. Children can also experience speech disorders due to changes in the shape of the mouth muscles after surgery. To help this condition, the child can undergo speech therapy guided by a special officer.
Risk of Cleft Lip Surgery
Cleft lip and palate operations are safe. However, as with other surgical procedures, lip and palate surgery can still cause complications, including:
- Bleeding.
- Infection.
- Respiratory disorders.
- Allergic reaction to the drugs given.
- Abnormal facial bone growth, including the face between the nose and lips.
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