- 1. Can surgeries for cleft lip and palate be done in the same sitting? If not how many surgeries do children with cleft lip and palate need and when?
Surgeries for cleft lip and palate are usually done in separate sittings. The timeline is as follows
Nasoalveolar moulding |
: Within 1 month after birth |
Cleft lip repair |
: 4 to 6 months |
Cleft Palate |
: 9 to 18 months (6 months after cleft lip repair) |
Surgery for speech |
: 4 to 6 years |
Surgery for closing cleft in the gums |
: 7 to 11 years(Alveolar bone grafting) |
Jaw Surgery (Orthognathic Surgery) |
: 18 years |
Definitive Rhinoplasty |
: 18 years |
- 2. When is surgery done for cleft lip?
Surgery for the cleft lip is done when the baby is 6 months old with an adequate weight of 4.5 to 5 kgs.
- 3. How is surgery done for the cleft lip?
Surgery for cleft lip is done under general anaesthesia. It usually takes about 1-2 hrs. In this the tissues around the cleft of lip are released and brought together to create a near normal lip both in terms of function and appearance.
- 4. How are patients with cleft lip managed post-operatively?
Child needs to stay in hospital for minimum of 3 days. It can vary according to child progress. Child can start fluids within 3 hours of surgery with spoon or paaladai and continue same for another month. Sutures usually used are absorbable hence not need to removed. Scar massage is initiated within 2 weeks after surgery.
- 5. When is surgery done for cleft palate?
The surgery for the cleft palate is done between 9 months to 18 months. It is generally done 6 months after the surgery for cleft lip.
- 6. Why should surgery be done for cleft palate?
Repair of the cleft in the palate is essential for good speech and to prevent the food in the mouth regurgitating into the nose.
- 7. How is the surgery done for cleft palate?
Surgery for the cleft palate is done under general anaesthesia. The tissue from the side of cleft is released, tissues in the palate moved around and sutured together in layers to seperate the nose from mouth. Raw areas will be there on the size and hence proper oral hygiene should be maintained.
- 8. How are patients with cleft palate managed post-operatively?
Child requires a minimum of 5 days stay in the hospital and this can vary depending on the child's and parents comfort regarding feeding. Child will be started on oral clear fluids within 3 hours of surgery. This will be given with spoon or paaladai. It will continue for a month. Strictly no sticky foods should be given. This is to avoid a break in suture line. There is no need for suture removal as suture used are absorbable.
- 9. What is Palatal fistula?
Palatal fistula is an abnormal communication between the nasal and oral cavity after cleft palate repair.
- 10. How common is palatal fistula?
The incidence of palatal fistula ranges between 0-76%.
- 11. How is the surgery for palatal fistula done?
The surgery for palatal fistula is done by mobilising the tissue from the rest of the palate or by using tissue from the tongue to close the defect in the palate.
- 12. How is surgery for palatal fistula managed post operatively?
Number of days of stay in hospital |
: 5 days |
Patient can drink water |
: 3 hrs after surgery |
Patient can eat normal food |
: Semisolid food from next day and normal food in 3 weeks |
Suture removal time |
: dissolvable sutures are used and hence they need not be removed. |
- 13. What is the post operative follow-up for surgery for velopharyngeal insufficiency (VPI)?
We would start speech therapy within 3 weeks. Regular speech therapy is the key for improvement and nasal endoscopy for monitoring.
Facts at a glance
Number of days of stay in hospital |
: 5 - 6 days |
Patient can drink water |
: 2 hours after surgery without introducing any object into the mouth |
Patient can eat normal food |
: 3 weeks |
Suture removal time |
: absorbable sutures would be used for surgery and hence removal would not be needed |
- 14. What is an alveolar cleft?
Alveolar Cleft is a discontinuity in the upper jaw dental arch due to the lack of fusion of the upper jaw bone.
- 15. Why should the alveolar cleft be closed?
Alveolar cleft is needed to maintain the bony continuity and facilitate tooth eruption. An intact upper jaw should be present if further procedures need to be done to change the position.
- 16. How and when is the surgery done for closure of the alveolar cleft?
The surgery for alveolar cleft is done prior to the eruption of the permanent canine tooth. The approximate age at which the surgery is done would be between 8 to 10years of age. Flaps are raised from the gums in the upper jaw near the cleft. Bone is harvested from the pelvic bone prominence on one side and packed into the cleft area within the flaps raised to recreate the dental arch.
- 17. How is the surgery for alveolar cleft managed post-operatively?
The patient is maintained on liquid diet for 2 days and is then started on semisolid diet. Upto 3 weeks. We encourage the patient to have good oral hygiene by brushing the mouth twice daily and using mouth washes after each meal.
Facts at a glance
Number of days of stay in hospital |
: 3 - 4 days |
Patient can drink water |
: 2 hours after surgery Started on soft mashed solids after 48 hours and advised not to chew but directly swallow. |
Patient can eat normal food |
: 3 weeks |
Suture removal time |
: absorbable sutures |
- 18. How important is a treatment with a dentist after alveolar cleft closure?
Follow up treatment with an orthodontist is important in bringing back the erupting tooth to normal alignment of the dental arch.
- 19. When and why is the underdevelopment of the upper jaw treated?
Due to the treatment of the cleft palate, the upper jaw may not develop well corresponding to the lower jaw. Hence there can be a flattening of the midface. Correction of the position of the upper jaw would also mean that the position of the teeth should be adjusted by the dentist so that the teeth would meet each other well after correction of the upper jaw. It is advisable to correct the underdevelopment of upper jaw after the full growth of the upper jaw is completed. Hence correction of the upper jaw is done after 16 years of age.
- 20. How is the surgery done for correcting the underdevelopment of the upper jaw?
Before surgery can be done to advance the upper jaw, the final plan is planned along with the dentist because after the operation, the teeth in both the jaws should meet well. After planning with certain plaster models, the dentist would apply dental appliances to correct the alignment of the teeth so that it would suit the future dental alignment. Surgery is then done whereby the upper jaw is cut within the mouth and is then advanced forward as planned earlier. In some cases, the lower jaw may also be cut within the mouth and then brought back to maintain the right alignment of the face. There will not be any sutures over the face. For further contour deformities on the face, fat can be harvested from the thighs or buttocks and injected into the midface.
- 21. What is the post operative follow-up for surgery for correction of the underdevelopment of the upper jaw?
The upper and lower jaws of the patient will be kept together with rubber bands so that there wont be inadvertent mouth opening. This is done to prevent moving of the jaw bones so that the jaw bones can settle in the new place. These bands will be removed in 3 weeks an dthen the patient is slowly asked to open and close the mouth. Patient will be on liquid diet for one month followed by mashed soft solid food for another month. In 3 months, the patient can eat normal food.
Facts at a glance
Number of days of stay in hospital |
: 3 - 4 days |
Patient can drink water |
: after 4 hours of surgery. |
Patient can eat normal food |
: 3 months after surgery |
Suture removal time |
: absorbable intra-oral sutures will be used and hence need not be removed. |
- 22. How and when is the nose deformity corrected?
Nasal deformity can be corrected initially while operating for cleft lip correction, this is called as primary rhinoplasty. It is advisable to correct the nasal deformity after the full growth of the upper jaw and the nasal complex which takes about 16 years of age. If the correction of the upper jaw is planed, then the correction of the nose is done after that
- 23. How is the surgery done for correcting the nasal deformity?
Each nasal deformity is thoroughly evaluated before surgery by taking photos and analysing the photos. We discuss in detail with the patient and the attenders, on what we would correct after the operation and what one can expect after the operation. The surgery is done under general anaesthesia. The only place where the incision for the nose would be visible is in the undersurface of the nose between the two external nostrils. Alterations in the cartilage and bones of the nose is done. Extra cartilage is usually required to build the nose and this is taken either from the septum of the nose or from a cartilage near the ribs in the chest. The surgery would take around 2 to 4 hours.
- 24. How is the surgery for correction of the nasal deformity managed post-operatively?
Nasal packs are kept inside both nostrils at the end of the surgery to avoid any nasal bleeding. These nasal packs are removed at the end of 2 days. A splint is applied on the dorsum of the nose to give protection to the nose. This splint is removed in 10 days. The patient is advised to take liquids on the day of surgery. Semisolid diet is started the next day and gradually the patient is asked to take normal diet. Swelling and bruising of the face is expected for the first few weeks after surgery which will resolve within a few weeks.
Facts at a glance
Number of days of stay in hospital |
: 3 - 4 days |
Patient can drink water |
: 4 hours after surgery. |
Patient can eat normal food |
: 3 - 4 days after surgery |
Suture removal time |
: Need removal between 5 to 7 days after surgery. |