Our Summary

This research paper is a comprehensive review of how doctors treat a condition known as bilateral cleft lip and palate (BCLP), where a baby is born with a split in both the upper lip and the roof of the mouth. This condition is particularly challenging to treat because the segment of the upper jaw that carries the teeth often sticks out more than usual.

The researchers looked at 381 studies and found that in 86% of cases, doctors repaired the lip before the palate. This was especially the case for patients under six months of age. However, this approach sometimes led to cosmetic issues or a receding mid-face. In some cases, to lessen the tension on the lip, doctors used special techniques to reshape the mouth and nose area before surgery or briefly joined the cleft lip together.

For older patients, doctors often repaired the palate first or moved back the protruding part of the upper jaw if it was sticking out more than 10mm. However, this sometimes made the upper jaw unstable or caused the mid-face to recede.

In summary, for younger patients, the lip is usually fixed first, followed by special pre-surgery techniques. For older patients, the palate is often repaired first, but the risk of complications is similar to that of younger patients.

FAQs

  1. What is bilateral cleft lip and palate (BCLP)?
  2. What is the common procedure in treating BCLP in babies under six months of age?
  3. What are the potential risks and complications of BCLP repair for older patients?

Doctor’s Tip

A helpful tip a doctor might tell a patient about cleft lip repair is to follow post-operative care instructions carefully to ensure proper healing and minimize the risk of complications. This may include keeping the surgical site clean, avoiding certain foods that could irritate the area, and attending follow-up appointments as scheduled. Additionally, it is important to communicate any concerns or changes in symptoms to the medical team promptly.

Suitable For

Typically, patients recommended for cleft lip repair are infants and children with cleft lip and/or palate deformities. The timing of the repair may vary depending on the individual patient’s age and specific condition. In general, cleft lip repair is recommended early in infancy, usually before six months of age, to improve cosmetic outcomes and facilitate proper feeding and speech development. Cleft palate repair is typically recommended later, around 9-18 months of age, to allow for proper growth and development of the palate and teeth.

Older patients with cleft lip and palate deformities may also be recommended for repair procedures, although the approach may differ from that of younger patients. In some cases, pre-surgery techniques may be used to reshape the mouth and nose area or to lessen tension on the lip before surgery. Additionally, for older patients with protruding upper jaws, additional procedures may be necessary to stabilize the jaw and prevent mid-face recession.

Overall, the recommended treatment approach for cleft lip and palate deformities may vary depending on the patient’s age, specific condition, and individual needs. It is important for patients and their caregivers to consult with a team of experienced healthcare professionals, including plastic surgeons, orthodontists, speech therapists, and other specialists, to develop a personalized treatment plan that addresses all aspects of the cleft lip and palate deformity.

Timeline

Before cleft lip repair:

  • Diagnosis of bilateral cleft lip and palate
  • Consultation with a team of specialists including surgeons, orthodontists, and speech therapists
  • Pre-surgical evaluations and planning
  • Surgery typically scheduled within the first year of life

After cleft lip repair:

  • Recovery period following surgery
  • Monitoring for any complications or issues with healing
  • Follow-up appointments with the surgical team
  • Speech therapy and orthodontic treatment as needed
  • Potential additional surgeries or procedures to address any remaining issues with the lip or palate

What to Ask Your Doctor

Some questions a patient should ask their doctor about cleft lip repair include:

  1. What is the recommended treatment plan for my specific case of cleft lip and palate?
  2. What are the potential risks and complications associated with the surgery?
  3. How long is the recovery process and what can I expect in terms of pain and discomfort?
  4. Will I need additional surgeries or treatments in the future?
  5. What are the expected outcomes in terms of appearance and function after the surgery?
  6. Are there any alternative treatment options available for my condition?
  7. What experience do you have in treating cleft lip and palate patients?
  8. What support services or resources are available for patients and families dealing with cleft lip and palate?
  9. How can I best prepare for the surgery and recovery process?
  10. Are there any long-term effects or considerations I should be aware of following the surgery?

Reference

Authors: Chang IA, Bassiri Gharb B, Papay FA, Rampazzo A. Journal: J Craniofac Surg. 2022 Mar-Apr 01;33(2):421-425. doi: 10.1097/SCS.0000000000008184. PMID: 34560740