Help for Parents

Cleft Lip and Palate (FLP)

Cleft lip and palate is the most common congenital malformation in the face and can have three types of presentations, cleft lip alone in approximately 10% of cases, cleft palate alone in approximately 20% and cleft lip and palate in 70% of cases, other presentations are very rare as facial clefts associated with complex craniofacial defects.

This malformation occurs due to an alteration in the fusion of the lateral nasal processes and the maxillary processes from day 25, that is, between the fourth and eighth week of gestation for the lip and between the eighth and eleventh week of gestation for the palate, which is characterized by a lack of fusion of the palatal processes in relation to an insufficient descent of the tongue, which precipitates a cleft lip and palate.

Microform

Incomplete

Complete

Cleft lip and palate is of great significance from a public health point of view, since it is the second congenital pathology that causes disability, if it is not treated in time and by experienced professionals. "If it is not treated in time and well, it generates a great disability that affects the patient and his family, who will suffer social stigma, discrimination, concealment, shame, and rejection for his facial anatomical and language alteration, which will produce loss of schooling with all the consequences in social integration, job training and development of independence with the consequent burden to the family and society. The most important thing is that all this is preventable with a timely and quality treatment, which aims to leave a minimal or imperceptible stigma on the upper lip and adequate speech, when this child goes to school which will allow a proper social and cognitive development, allowing him to realize all his dreams.

Current diagnosis

The diagnosis of cleft lip and palate is becoming more frequent in the gestational stage in the second trimester of pregnancy using 2D ultrasound the ranges are 0-73% for all types of clefts with a low false positive rate. In case of high risk of clefts 3D ultrasound has higher detection rates 100% for cleft lip, 86 to 90% for cleft lip and palate and 0 to 89% for cleft palate alone, the disadvantage is the high cost, the examination time and the need for more experience by the operator.

After birth the diagnosis is evident, although there are cases of greater diagnostic difficulty with emphasis on submucosal cases. Subsequently these patients require more specific diagnoses such as nasopharyngeal insufficiency, which should be completed with nasofibroscopy in order to provide important information for the choice of the most appropriate surgical technique in each case.

Classification

Unilateral lip fissure: It can be complete when the defect invades the nostril (pisonasal), incomplete when the defect does not invade the nostril and has a band of skin called Simonart's band, or frustrated when the skin only presents a very subtle notch, however, the orbicularis oris muscle of the lips is fissured preventing a natural smile.

Bilateral lip fissure: In these cases any of the possible combinations can occur, being the most complex diagnosis the complete cleft lip on one side and frustration on the contralateral side, the cleft lip goes from the lip to the anterior palatal foramen, therefore, it can involve the alveolar area and the premaxilla on one side or both sides.

Cleft palate: This can be anterior or hard palate or posterior and soft palate and can also be accompanied by cleft lip or be isolated. If it is isolated, it is frequent that it is associated in almost 50% to syndromic, which can make more difficult its prognosis of phonation. The cleft palate can be complete when it compromises the hard palate and the soft palate (from the anterior incisor foramen to the uvula) or incomplete cleft palate when it does not reach the anterior incisor foramen) being the incomplete bilateral the most technically difficult for the surgical management and the posterior cleft palate the most frequent.

Multidisciplinary management of the cleft child

The patient with cleft lip and palate will require a team of specialized and experienced health professionals to provide comprehensive and integrated care in order to solve the multiple congenital problems that his condition will have. An important concept is that the first opportunity is unique for an extraordinary result, therefore the surgeon who operates these patients must have experience and continuity, that is to say, to operate between 50 and 100 surgeries of this type per year.

This team is generally organized and directed by a plastic surgeon without this being mandatory or exclusive for other professionals to lead the team. Currently many teams in other countries are led by dentists or other health professionals.

This team is composed of the following specialties: