Cleft lip not only affects a child's appearance but also impacts speech, swallowing, and breastfeeding. Therefore, children urgently require multiple surgeries to correct this congenital defect. The treatment of cleft lip and palate involves multidisciplinary specialists—including oral surgeons, orthodontists, plastic surgeons, otolaryngologists, and speech therapists—collaborating to develop a personalized treatment plan and specific timeline for each patient. This is known as comprehensive sequential treatment.
Factors Contributing to Cleft Lip:
Genetic Factors: Most affected children have direct or collateral relatives with the same deformity. Studies indicate a cleft lip incidence rate of 0.17%. If one parent has a cleft lip, their offspring's incidence rate can reach 2.6%–5.6%, representing a 15–32 times higher risk.When the father has cleft lip and palate, the incidence rate in offspring is approximately 3%. If the mother has the condition, the probability of transmission to children rises to 14%. For healthy parents who have already had one child with cleft lip, the chance of having a second child with the condition is 4%. If two children with cleft lip have already been born, the probability increases to 9% in subsequent pregnancies. The incidence rate is even higher among children of consanguineous marriages.Nutritional Factors: Vomiting and dietary restrictions during pregnancy can impair nutrient intake, leading to vitamin deficiencies. Animal studies show that feeding pregnant mice diets lacking vitamins A and E often results in offspring with cleft lip and palate.
Viral infections: Exposure to rubella virus during early pregnancy (within the first two months) may cause cleft lip and palate in the infant.
Endocrine Effects: Studies show that injecting pregnant mice with corticosteroids on days 9, 10, and 11 of gestation resulted in a higher incidence of cleft lip and palate in their offspring. Therefore, during early pregnancy (within 8 weeks), factors like severe stress or trauma in the mother can increase corticosteroid secretion, potentially causing congenital malformations in the infant.
Radiation: Exposure to radiation during early pregnancy may cause cleft lip and palate in the fetus.
Five-Step Repair Process for "Cleft Lip"
First, Preoperative Management. The birth of a child with cleft lip and palate is undoubtedly a severe blow to parents, making extra care and compassion essential. Physicians should register the child for long-term follow-up.Obstetricians, gynecologists, and pediatricians conduct comprehensive physical examinations, address concerns, instruct on proper feeding techniques, and inform family members about precautions throughout the cleft lip and palate treatment sequence. Second, cleft lip repair surgery. Unilateral cleft lip repair is typically performed when the infant is 3 to 6 months old, while bilateral cleft lip surgery is usually conducted between 6 and 12 months of age.This is usually performed when the child is 12 to 18 months old.
Fourth, Postoperative Management. Although the cleft palate is repaired at this stage, the child may still exhibit significant nasal speech. Speech evaluation should be conducted within six months post-surgery, with early speech therapy initiated. If speech does not improve significantly, a secondary pharyngoplasty may be considered around age 4 to 5.Additionally, children with cleft lip and palate often have misaligned teeth, which can be addressed through orthodontic treatment. Fifth, treatment for secondary jawbone and facial deformities. For severe cleft lip and palate cases, ages 9 to 11 are considered the ideal window for alveolar cleft bone grafting.Furthermore, since it is challenging to achieve satisfactory correction of all nasal-labial and maxillofacial secondary deformities in a single procedure, secondary reconstructive surgery should be performed after the child has completed growth and development (around age 17-18 for males and 15 for females).
The treatment process for cleft lip and palate spans the entire growth and development period, requiring close cooperation between the child's parents and the medical team. Only through such collaboration can optimal treatment outcomes be achieved.