During the pregnancy, the lip structures on the right and left sides and the palate region of the mouth merge in the midline and form and grow together during the developmental stages of the mother's womb. In the first weeks of development, long before the child is born, the left and right edges of the lip and the palate are formed together. However, the normal intercourse does not occur in approximately one in 1,000 babies. In some societies, in every 500-800 births, some of these structures do not fully unite in a child and openings called clefts occur in the mouth and palate region. Because the lip and palate develop separately, the cleft lip and palate can occur in various ways. In recent years, the significant progress has been made in the treatment of children born with the cleft lip and palate, and there are no obstacles for most of you to lead a normal, healthy and happy life. Due to the individual differences, some of your questions cannot be answered here. Do not hesitate to ask any questions you can have about the surgical intervention, even over the phone.
If the opening occurs in the lip area, it is called as cleft lip (hare lip), and if it occurs in the palate area, it is called as cleft lip. The cleft lip and palate can be seen separately or together. For the family, who has prepared themselves for the baby to be born, learning that the baby has a cleft lip and palate can cause great disappointment. It is often possible to see this deformity with the USG during the prenatal pregnancy follow-up. It is not always possible to see the cleft palate. If your baby has such a condition, your doctor will recommend you to have surgery. With the developments in the plastic and aesthetic surgery, very successful results are obtained in the surgeries of the patients having the cleft lip and palate. Thus, your child will have a normal happy and healthy life. When the surgery is performed by a plastic surgeon experienced in the cleft lip and palate, the results are successful.

Team approach
The children born with the cleft lip and palate need help from the different specialties due to the various accompanying problems. In addition to the cleft repair performed by the plastic surgery, the various problems can arise in terms of the nutrition, development and arrangement of teeth, hearing, speech and psychological development, which will change as the child grows. Therefore, it is important that these children receive team support.
Generally, in this type of team,
plastic surgeon,
pediatrician,
otolaryngologist,
psychologist,
nutritionist,
social counselor take place.
To apply which of these specialists and when is coordinated by the plastic surgeon.
It is possible to achieve a good result if the surgical intervention is performed by a plastic surgeon experienced in the cleft lip and palate repair. However, as with any operation, there are various risks and complications that can be encountered. The most common problem after the cleft lip repair is the lack of symmetry on both sides of the lip. In the first operation, the cleft lip is removed in a way that ensures the aesthetic and functional integrity. The main purpose of the lip repair is to close the cleft in a single operation, but a second operation can be necessary from time to time. The main purpose of the cleft palate repair is to close the opening in the palate and to ensure that the child is fed and able to speak properly. From time to time, the various healing problems and speech disorders require a second attempt.
As it is with any surgery, this surgery has risks. The additional anomalies, including the cardiovascular system, can be observed in some patients having the cleft palate in particular.
It is possible to minimize the risks with the pre-operative evaluations. Sometimes, the secondary surgeries can be required. In the cleft palate surgery, the cleft in the palate region of the mouth is closed. Thus, the child will not have difficulty in eating and talking. Rarely, the secondary surgeries can be required due to the wound healing problems or speech difficulties.
The nutritional problems can develop in the preoperative period. The children having the cleft palate cannot be fed in the supine position; since there is no integrity of the palate, the food they eat escapes into the nose and trachea, by causing the lower respiratory tract infections. It is necessary to feed in a sitting position, with a spoon and at the frequent intervals. The baby cannot be able to perform the sucking function of the cleft lip. After the breast milk is expressed, it can be necessary to feed with a spoon in the same way as stated before. The middle ear infections are common, especially in the children having the cleft palate. In such cases, the medical or surgical treatment can be required.
Planning the Surgery
You can learn about the details such as where the surgery will be performed, the type of anesthesia, the problems that can be encountered, and the recovery period, the cost of the procedure, and the result, here and in face-to-face meetings.
Generally, the surgical interventions are started with the cleft lip in the first session. The first surgery is performed between 4 and 6 months. In the meantime, it is expected that the blood values and weight of the baby have reached certain figures. The cleft palate repair can be performed between 3 and 12 months, depending on the patient's condition. The cleft palate repair is an intervention that requires more extensive surgery than the cleft lip. So starting from the 6 to 9 months, it is recommended to be done after one month. In this way, it becomes easier for the child to tolerate the surgical procedure. However, it is necessary not to exceed the 18th month in order for the speech to be provided properly. That is, the surgery should be completed before the child begins to speak.
Lip cleft repair:
In babies with both cleft lip and palate, the repair is first initiated with the cleft lip repair. The cleft lip can be seen in different ways, from a wide cleft that covers the area from the nose to the back of the lip area just behind the teeth, to a simple notch. It can be bilateral or unilateral. The surgery is usually performed between 4 and 6 months. In the meantime, it is expected that the blood values and weight of the baby have reached to the certain figures.
The surgery is performed under the general anesthesia, takes about an hour and a half, and stays in the hospital for one day. To repair the cleft lip, the muscle repair will be performed following the incision to be made on both sides of the cleft. The cleft will be closed by repairing the oral mucosa and skin. In this way, the muscle will gain function and the normal lip shape will be formed. The deformity of the nose will also benefit from this intervention. In the surgery, the wrongly connected muscles are released and normal lip muscle integrity is restored. In the surgery, attention is paid to the correct repair of the red skin and normal skin junction of the lip, which we call the vermillion line, to coincide the skin sutures on the cubid line, which we call the eros arc, to lengthen the lip if there is a shortness or length difference. The deformities in the nostril accompanying the cleft lip are also repaired in the same session.
Your child can have a restless period after surgery. To alleviate the post-operative pain, the lip is anesthetized with a long-acting anesthetic drug during the surgery. In the postoperative period, the simple painkillers and antibiotics are started orally. In the first few weeks, it can be necessary to tie the arms to prevent the baby from damaging the surgical field. To keep your child's hands away from the surgical field, the bandages are used to prevent bending of the elbows. In the first few days, the closed dressing is done, followed by the dressing with the antibiotic skin pomades. The stitches are removed in 7 days. The stitch removal can sometimes be done in the operating room. The suture materials used in the mouth will melt and fall off by themselves, depending on their type. It is given by writing down a feeding chart and regimen with the recommendations for your child's diet for the first few weeks. As a normal result of the wound healing in the first 3 months, the suture line is more prominent and red than the surrounding structures, but then gradually fades to a color close to the normal skin. The surgical scar becomes redder and wider in the first few weeks. This appearance will decrease over time, but the scar will never completely disappear. In many children, this scar will turn into a barely visible shape due to the shadows in the nose and lip area.
Palate cleft repair:
The cleft palate is in the form of a small notch that affects the small tongue in some children, while in others it extends to the lip area. The cleft palate repair can be performed between 3 and 12 months, depending on the condition of the surgeon, anesthesiologist and patient. The cleft palate can be seen bilaterally or unilaterally, across the entire palate, or accompanied by a partial palatal detachment. The cleft palate repair is an intervention that requires more extensive surgery than the cleft lip. So, after 6 to 9 months, it is recommended to be done after one month. In this way, it becomes easier for the child to tolerate the surgical procedure. However, it is necessary not to exceed the 18th month in order for the speech to be provided properly. That is, the surgery should be completed before the child begins to speak. During the surgical repair, with the incisions made on both sides of the cleft, the tissues on the margin are brought closer to the midline and the integrity of the palate is ensured. During this repair, the soft palate muscles are also repaired, thus providing the necessary ground for the child to speak and feed correctly. The surgery is performed with the general anesthesia and takes about two hours.
In the surgery, the plastic surgeon frees the palate mucosa and muscles along the cleft lines from the wrong junctions as flaps, without disturbing the blood supply, and joins them to the midline. The nose and mouth sides of the slit are closed separately. The separated muscles are joined at the midline. The minor tongue is created. Thus, the plastic surgeon not only ensures the integrity of the palate so that there are no clefts or holes, but also provides the formation of a functional palate, where the baby can speak and eat properly by suturing the muscles of the palate together and lengthening the palate.
The antibiotics and pain relievers are started after the surgery. In the first one or two days after the surgery, there can be complaints of the discomfort and pain, which can be easily controlled with the medications. A special nutritional regimen is applied in the postoperative period. The first few weeks are fed with the liquid transparent foods. The hands can need to be tied with the swaddles or gloves for the first few weeks to prevent the damage to the stitches. The compliance with these recommendations is necessary for the smooth healing of the palate. The healing of the wounds in the mouth is more difficult than the healing of the lip wounds and the probability of developing a problem is higher. Therefore, the recommended diet and rules should be strictly observed.