Cleft Lip and Palate: Causes, Types, Clinical Features, and Surgical Management

Cleft Lip And Palate

 

Her cleft lip results from abnormal median nasal and maxillary process development.

Cleft lip Causes

• Increase parenteral age.
• Infection during pregnancy.
• Smoking and steroid therapy during pregnancy.
• Trauma and psychological stress during pregnancy.

Read And Learn More: General Surgery Questions and Answers

Types Of Cleft Lip

• Central: It is very rare and occurs due to the failure of the fusion of two median nasal processes (Hare’s lip).
• Lateral: It is the most common variety, there is a cleft between the frenum and the lateral part of the upper lip.
  This is due to the imperfect fusion of the maxillary process with the median nasal process. Lateral variety can be unilateral or bilateral

• Complete or incomplete: In case of complete variety, the cleft lip extends to the nose. In incomplete variety, the cleft does not extend up to the nostrils.
• Simple or compound: A simple cleft lip is only cleft in the lip while compound refers to cleft lip associated with a cleft in the alveolus.

Cleft lip Clinical Features

• The patient has difficulty in sucking.
• Defective speech is present, i.e. patient is unable to speak words such as B, F, M, P, and V
• Presence of soft tissue mass in between the ends of bone which unites tongue to lip.
• In hare lip cleft lies in the middle of the lip.
• In incomplete cleft lip, extension is from the nostril to some distance forward
• In complete cleft lip, extension is from nostril to palate.

Cleft lip Treatment

• Millard’s criteria are used to undertake surgery for cleft lip,i.e. Rule of ten, i.e. 10 pounds in weight; 10 weeks old; 10 g% hemoglobin.
• If the cleft lip is bilateral and is extensive two surgeries should be done to close the cleft.
  Surgery on one side should be done first and later on after a few weeks surgeries on the second side are done.
• Millard’s rotation advancement technique is commonly used. In this correction of both lip and nasal deformity is done.
  Realigning muscles and lips and their correct anatomical position is an important part of this repair.
  In this method, a tilted cupid bow is rotated downwards following a curved incision extending to the columella.
  This allows rotation of the misplaced cupid’s bow and philtrum dimple in a normal position.
  A high rotation gap created is filled with a triangular flap which consists of skin muscle and mucosa from the upper part of the lateral side of the cleft.
  The resultant scar is hidden inside the nose or follows the natural line of philtrum.
• Hagedorn LeMesurier repair: In this method medial lip element should be lengthened by introducing the quadrilateral flap which is developed from the lateral lip element.
• Tennison Randall repair: In this, a cut is given on the lower one-third of the lip to correct the upward tilt of Cupid’s bow by placing a Z-shape wire.
  The gap is filled with a triangle of skin, muscle, and mucosal flips from the lower end of the lateral lip element. This resultant scar is a Zigzag scar.
• Proper postoperative management like control of infection, training for sucking, swallowing, and speech therapy should be done.

Principles of Cleft Lip Repair

• Rule of 10 should be fulfilled.
• Before six months it should be operated.
• Infection should not be present.
• Millard advancement flap is used for unilateral cleft lip repair.
• Bilateral cleft lip repair can be done either in single or two stages.
• One-stage bilateral cleft lip repair is done using the Veau III method.
• Proper markings are made before surgery and the incision should be over full thickness flap.
• Often 1:2,00,000 adrenalin injection is used to achieve hemostasis.
• Three-layer lip repair should be done, i.e. mucosa, muscle, and skin.
• Cupid’s bow should be horizontal.
• The continuity of the white line is maintained.
• Vermilion notching should not be present.