Q. What can we do to manage the cleft baby?
 

A. Special care should be taken to the cleft baby from the birth. Although there is individual difference, several times of admission and surgery are necessary. We’ll show you the sequential management of this cleft baby.

1.     ~1 year old: When they are born, consultation to the pediatric specialist about the genetic counseling and breast feeding should be preceded. Around the age of 10 weeks, cheiloplasty is planned. The purpose of this surgery is attaching the separated lip with minimal scar and improving the aesthectic and functional growth. At the same time, primary rhinoplasty to restore the normalized shape of the cleft side nose. In case of cleft palate, palatoplasty should be planned around the 11 months. With the cleft palate, they tend to have otitis media due to the disturbed muscle function. Therefore, consultation to the ENT specialist should be preceded around 6 months and simultaneous tube insertion must be considered. Most of the cleft palate patients have normal pronunciation, however they have possible tendency of slowed speech development and articulation problem, therefore co-work with speech therapist should be started around 3 ~ 6 months of age and follow-up should be made every 6 ~ 12 months.

2.     1~2 years old: Around age of 1, palatoplasty and follow up for the cheiloplasty is planned. The main purpose of the palatoplasty is closure of the palate so that the patient can eat, drink, and pronunciate with normal articulation. Cooperation with dentist at this time includes the molding the dental cast and taking cephalogram. ENT specialist inserts the tube in the tympanic membrance if there is evidence of otitis media. Speech therapist analyses the speech and pronunciation.

3.     2~6 years old: Follow-up of the surgical outcome of cheiloplasty and palatoplasty is tried. If there is nasal sound with speech problem following the palatoplasty, velopharyngeal surgery is considered. In case of cleft lip, severe nasal deformity can be corrected at the age of 5~6 with primary rhinoplasty. With the bilateral cleft lip patient, surgery for the elongation of the columellar may be needed. At the age of 2~5, ENT specialist should make an auditory examination. Dentist makes a regular examination for the dentition and gummy state. When these children grow up to the age of 2, they are aware of the reaction of others and have interest in their appearance and pronunciation, And at the age of 3, they respond and answer to others’ reaction and have some fear about the hospital and surgery. For the appropriate adaptation at this age, consultation to the psychological specialist is necessary.

4.     6~12 years old: For the enhancement of the aesthetic property, cheilorevision and 2ndary rhinoplasty are planned. These procedures are inevitable because the muscles around the mouth are not able to grow in normal pattern even after the successful primary lip and nose surgery. Obtaining the symmetry and balance of the nose can make the child look better. It is highly desirable if the scar can be removed, however this is not possible. Instead of this attemption, symmetry and balance of the core structure of the lip should be restored. Problematic articulation and nasal sound should be corrected with velopharyngeal surgery. If there is alveolar cleft, alveolar bone grafting from the iliac crest and orthodontic treatment should be considered following the dental radiologic evaluation. ENT specialist continues to examine the auditory function. Speech therapy and psychological support should be caught up with this treatment as well.

5.     12~18 years old: If there remains the developmental abnormality in the face, orthognathic surgery should be considered. Orthodontic treatment is mandatory if there is necessity of orthognathic surgery. Speech and psychological evaluation should be continued.

6.     After the 18 years old: If needed, another orthognathic surgery can be considered, and the orthodontic treatment is completed.