The cleft lip can affect one or both sides of the upper lip, with varying degrees of severity. If it affects only one side, it is called unilateral or unilateral cleft lip and if it affects both sides, it is called a bilateral cleft lip. The cleft lip can often bind to the cleft palate, in its various portions: the front part, bone, is defined as hard palate, and the rear part, free of bone, is defined soft palate and moves during phonation by specific muscles actions.
Diagnosi: During echographic visit during pregnancy, starting from the 12th week prenatal diagnosis of cleft lip and palate may have been made.
Trattamento: The aim of surgery is to repair the lip and nose area of the cleft in the most aesthetic and functional manner. The child will have a good harmonious look. Goal of the surgery is to close the palate area of the cleft so that the palate can function normally during the suction and language: All avoiding as little as possible facial skeleton growth
Repair is carried out in two times. Depending on the clefts width two different procedures are applied.
Isolated cleft lip and cleft palate
in these cases usually only one single intervention is enough. For the lip intervention is around 6 months. The response times are only estimates since it can be changed in relation to the child itself.
Treatment of complete cleft lip and palate (labiopalatoschisis), mono-and bi-lateral.
In the more extensive or bilateral forms, at around 6 months, the child who has reached a stable weight, also subject to screening for other possible health problems and proved to not to be subject to eventual anesthesia risks, undergoes surgery for correction of the lip and nose and the soft palate closing. In cases in which it’s possible already from this first intervention to shut also the hard palate this will be repaired together with the soft palate, the lip and the nose during the same surgical procedure.
In these cases the alveolus, that is the area where teeth will grow, will be repaired around 6-8 years with bone graft. For cases instead in which the hard palate has been left open, with a second intervention, around 18/36 months, the hard palate and the alveolus(gingival and alveolar surgery), will be repaired, in this case without the need of any following bone graft intervention. In a small percentage of children, around 4-5 years by speech therapist indications they may need further surgery to improve phonation.
Following corrections of the lip, nose, nasal septum and a possible underdevelopment of the maxilla or in preschool period (if severe) or when the child has grown puberty may be necessary.