Correction of Congenital Anomalies (Cleft Lip-Palate, Congenital Hand Anomalies)

The condition known as cleft lip and palate deformity is seen on average in 1/1000 births and occurs between 8-12 years of age during the development of the baby in the womb. It is an anomaly that occurs due to developmental disorders that can be seen in weeks. This anomaly is caused by a small notch on one side of the lip; It has a spectrum ranging from a wide bilateral cleft involving the nose, lips and palate.

 

The biggest problem seen in the early period in babies born with this anomaly is the slow development of these children due to feeding difficulties, and frequent middle ear and upper-lower respiratory tract infections. This very common anomaly can be completely corrected with a good and regular multidisciplinary team approach, and children born with this anomaly lead a completely normal life.

 

Surgical repair of a cleft lip aims to normalize the anatomy of facial features. Since the lip is both an aesthetic and a functional organ, the result should create both aesthetics and function. Since nasal deformity will always be seen in cleft lip cases, the aim is to create the lip mucosa and skin symmetrically together with the working lip muscles, while aesthetically forming the Cupid arc with philtrum columns and vermillion tubercle. Symmetry of the nostrils, a sufficient nasal lining and columella length, and a symmetrical and adequate nasal tip projection and symmetrical nostrils are the aims of nasal treatment.

 

Treatment of babies with cleft lip and palate begins in the first 48 hours after birth. While some surgeons perform cleft lip surgery in the first week after birth, some surgeons consider this operation in the 2nd-6th week after birth, taking into account the development of the child. they do it for months. These methods are generally not very different from each other. The Plastic Surgeon prefers whatever teaching he has received during his training. Families need not worry about this. On the other hand, regardless of the level of deformity, the baby should be evaluated by an orthodontist immediately after birth and a regular development of anatomical structures should be ensured with various intraoral or extraoral devices according to the type of deformity. In the Far East, where this deformity is common, preoperative orthodontic treatment is very well applied, but unfortunately, its application is only provided in certain centers in our country. In addition, these babies should be examined by a pediatrician immediately after birth to determine whether there is an additional anomaly. In the meantime, psychological support should be provided to parents (especially if a prenatal diagnosis of cleft palate and lip has not been made). Since the sucking function is not sufficient in these babies, the mother is told about the feeding style of the baby (on the lap and with a spoon or a special bottle and using an intraoral obturator in babies with cleft palate).

 

Babies with cleft lip are mostly operated in 2-3 months after birth. It is important that the baby's weight increases and develops before the operation. In babies who are not developing well, it is best not to have surgery until the problem is resolved. It is necessary to show that the blood values ​​such as hemoglobin, hematocrit, bleeding coagulation time are at normal levels by preoperative analysis of the baby. Since these cases are always operated under general anesthesia, it is essential to prepare the baby very well before the operation. Patients are usually kept in the hospital the day and night of the surgery and are sent home the next morning. The feeding of babies is in the form of feeding with a spoon in a sitting position, starting from the day of surgery. Contamination of the incision lines with nasal discharge and food should be prevented. For this purpose, the incision is dressed with antibiotic ointments every day. It is important to keep the wound lines dry. 5-7 days after surgery. All sutures are removed on days.