Cleft Lip and Palate

WHAT IS CLEFT LIP AND PALATE?

• The Cleft Lip and Palate is a malformation that occurs during gestation. It involves an incomplete fusion of the structures of the oral cavity, affecting the normal development of the nose, lip, and palate.

• Its extent is variable and can affect the palate region (palatine cleft), the labial region (cleft lip or harelip), or both. The palatine cleft occurs when the palate has a direct communication with the nasal cavity. The cleft lip (or harelip) manifests itself in the upper lip and can extend up to the nose.

TThe Multidisciplinary Protocol of the Portuguese Institute of the Face

The treatment protocol of the Portuguese Institute of the Face is based on the individualization of each case through a comprehensive study of the affected structures, as well as a multidisciplinary follow-up that promotes better functional and aesthetic results throughout growth.

The approach at an early stage will allow for a more harmonious facial development and will avoid more complex treatments in the future.

A) Prenatal care

After the ultrasound where the diagnosis is made, our team follows up with the family as well as prepares them for the birth. At this stage, we address the family's initial questions and concerns. It is an important phase of education regarding post-birth care and planning for the next steps.

Our protocol includes support from psychology, speech therapy, nursing, and surgery.

B) First consultation after birth

Nos primeiros dias após o nascimento, o recém nascido é observado em consulta multidisciplinar com o cirurgião e o terapeuta da fala, onde, pela primeira vez, se observa o bebé, avaliam-se as estruturas associadas à malformação e define-se o plano de tratamento, de acordo com a caracterização da fenda.

C) Surgical Treatment

The surgical treatment plan to be adopted depends on the characteristics of the malformation, namely the structures affected. Typically, the first surgery occurs in the first months of life.

At the Portuguese Institute of the Face, we have different surgical options tailored to each case: 

1. Cheiloplasty: this is a surgery aimed at closing the cleft lip. If applicable, a primary nasal reconstruction may be performed at the same surgical time. It is usually indicated between 3 and 6 months of age. 

2. Palatoplasty: this aims to close the structures of the secondary palate - the hard palate, the soft palate, and the uvula. It is generally indicated from the 9th month onward. 

3. Velopharyngoplasty: this surgery is performed in the palate region and aims to improve speech when it is nasalized. It is recommended to be done between 2 and 3 years of age. 

4. Alveolar bone graft: this aims to fill the bony defect in the alveolar region, increase the stability of the maxilla, and allow dental eruption in the graft area. It can be performed at various ages starting from 2 years. 

5. Maxillary expansion: this surgery aims at the distraction of the upper jaw. 

6. Orthognathic surgery: this aims to correct dental-facial deformities resulting from malformation, which become apparent after the patient has reached full growth. Therefore, it is indicated starting from adulthood. 

7. Rhinoplasty: in adulthood, one may undergo this surgery to promote functional or aesthetic changes to the nasal structures. 

D) DENTOFACIAL ORTHOPEDICS AND ORTHODONTICS

The dentofacial orthopedics and orthodontics will follow the patient over the years, in order to monitor and provide better development and growth of the jaws. Depending on the type of cleft, these therapeutic areas can accompany the child from the first month until adulthood.

E) Speech Therapy

Speech therapy sessions begin in the prenatal phase, serving as an important tool to best prepare the feeding of the newborn. Moreover, throughout the different stages of the child's life, close monitoring of speech therapy is essential, especially during phases of introducing new foods or when the child starts to say their first words.

Other orofacial alterations in newborns 

There are dentofacial alterations in newborns that can impact breastfeeding. Since breast milk has numerous benefits for the newborn, it is important that these alterations do not have a negative impact on either the baby or the mother's comfort.

There are cases where the difficulty in adaptation is due to orofacial alterations, such as short tongue or lip ties. These can prevent the proper positioning of the tongue or lip and cause an inadequate latch.

The correction of the tongue or lip tie is simple and quick and will allow for a more adequate and less uncomfortable and painful breastfeeding experience for mothers.