Dr. Abd Allah Issam Abdullah Qattan * The cleft lip is a split in the upper lip as a result of the incomplete fusion of the parts that make up the lip (and sometimes the roof of the throat) during the fetal formation stages in the first three months of pregnancy. The degree of fissure ranges from a partial cleft in the upper lip only to a complete cleft that includes the upper lip and reaches the base of the nose and extends to the slices of the throat sometimes. And the split may be on one side (the right or the left side, or both sides). The most common case is a partial fissure of the left lip.
This case is one of the common cases and statistics indicate that one out of every 700 babies is born with cleft lip. Often these children are healthy and free from other diseases, but cleft lip may be part of another pathological syndrome, so the medical team must ensure the safety of the child in the postpartum period. The main factor causing this condition is unknown, but there are some genetic and environmental factors that studies have proven to be related to cleft lip cases. The presence of cleft lip in one of the parents or brothers is one of these factors. The percentage of birth of a child with cleft lip increases by 7-14% when there is another person in the family with the same condition. The percentage varies according to the relationship of kinship and the number of people infected. A mother''s smoking during pregnancy and having some viral infections during pregnancy may increase the likelihood of having a baby with cleft lip. There are some medications, the most important of which is acne medication or cortisone, which has been linked to congenital anomalies in fetuses. The woman must make sure of the doctor who is monitoring her pregnancy before starting to use any medications during pregnancy. And some doctors may advise that you stop using some medications for the period before pregnancy as well. But with all these reasons mentioned, most cases of cleft lip that we see are in healthy children and pregnancy is free of these causes and the defect is only a disorder in the formation of the lip that is not related to known matters. And the parents in this case must know that this injury is not a result of negligence, negligence or their mistake during pregnancy.
Treating these cases requires an integrated medical team made up of doctors, health professionals in various specialties, including plastic surgery, ENT surgery, a dentist, a pediatrician, speech and hearing specialists and psychologists. The treatment phase starts from the first months after birth, and it is necessary to set a clear plan for the parents, as they are a key factor in the treatment phase. This treatment journey continues until the child reaches the age of 16-18 years.
The number and quality of surgical and non-surgical procedures and interventions depends on the degree of lip cleft and the accompanying symptoms of a cleft throat or nasal deformities. In this article, we will focus on the cleft lip only, and I will devote other articles - God willing - to cleft palate in the future.
During the first months of the child''s life, the focus is on educating parents on how to deal with the child and the correct methods of breastfeeding.
These babies may have difficulty feeding, especially if the lip cleft is complete and accompanied by a cleft in the roof of the throat. In these cases, the parents are required to use special nipples for feeding to compensate the child for his inability to pump during breastfeeding.
It is also important that the quantity of feedings be small and sporadic rather than large quantities of feedings and that the child is in a somewhat elevated position (not completely flushed). In cases of complete cracking of the lip that reaches the nose, some doctors resort to straightening methods in order to try to reduce the distance between the two ends of the incision to facilitate the surgery in the future. The simplest of these methods is to put medical tape on the lip on both sides to try to bring the two sides closer. And the commitment of the parents to do the sticking leads to tightening the skin to be more relaxed, which facilitates the process of correcting the lip and helps give better results, God willing.
As for surgeries, these children need several operations to correct the existing deformities, and each operation takes place at a certain age because it is not possible to correct all the deformities in one operation. The first of these operations is the cleft lip correction surgery, which is usually performed when the child or child is 3-5 months old. This operation and other operations are under general anesthesia and the reason for delaying the first operation until this age is to give the child an opportunity to grow and mature all his organs and to ensure that he is free of any other organic diseases. After the first three months, the child''s body will be able to withstand complete anesthesia, which is safe, God willing, as long as the child''s general condition is normal. In this operation, the lip fissure is surgically corrected by suturing the outer skin of the lip, the muscles of the upper lip, and the inner layer of the lip, in addition to partial correction of the deformity in the nose. The final rhinoplasty operation is when the patient is at least 16-18 years old. The reason to postpone the final operation at this age is to give the nose a full opportunity to grow, because operations at an early age may cause tissue damage and greatly impede the growth of the nose. The desired goal of lip correction surgery is to obtain a symmetrical, somewhat symmetrical lip with the opposite side in terms of the lip contour, its outline and the red lip. Since this correction is by surgery, it is normal to have a wound that has a trace. But this effect is within the terrain and the details in the lip to reduce its clarity in addition to that the effect of the wound is greatly reduced with the passage of time if the parents adhere to the program of massage and tension of the wound after the operation. The process of correcting the cleft in the roof of the throat is at the age between 12-18 months, and the child may need an operation at the age of 9 years in the gums with bone implants, and as we mentioned previously, a nose operation at the age of 16-18 years. A percentage of children may need a minor operation between basic operations to correct minor parts or protrusions on the lip.
