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Cleft Palate Before And After Surgery

Different Inherent Patterns For Cleft Palate By Race Sex And Syndrome

Before and After Cleft lip Surgery Baby – Amazing Surgery Results & Journey

The true incidence of cleft lip and palate is controversial. Current genetic research does not segregate cases by syndromic involvement. Despite this, awareness of the categories is important to provide appropriate genetic counseling to the affected individual and his or her family. The general prevalence of cleft lip with or without cleft palate is believed to be 1 case per 700 live births. The prevalence of nonsyndromic cleft palate alone is believed to be lower .

The distribution of clefting is influenced by the sex of the individual. The occurrence of nonsyndromic cleft lip with or without cleft palate is higher among males, while nonsyndromic cleft palate is more common among females. The rate of occurrence in one monozygotic twin is as high as 50%. The prevalence of nonsyndromic cleft palate differs little across racial lines however, distribution of cleft lip with or without cleft palate varies widely with ethnicity. Analysis of data indicates that Native Americans have the highest prevalence of this type of facial cleft, while blacks have the lowest prevalence. Nonsyndromic cleft palate occurs as follows:

  • 1 case per 1500-3000 whites

  • 1 case per 200-5000 blacks

  • 1 case per 1600-4000 Asians

  • 1 case per 1700 Native Americans

Estimate of cleft lip with or without cleft palate is as follows:

  • 1 case per 775-1000 whites

  • 1 case per 1300-5000 blacks

  • 1 case per 400-850 Asians

  • 1 case per 230-1000 Native Americans

After The Surgery For Cleft Palate

This surgery is usually more involved and can cause more discomfort and pain for the child than cleft lip surgery. Your child’s physician may order pain medicine to help with this. As a result of the pain and the location of the surgery, your child may not eat and drink as usual. An intravenous catheter will be used to help give your child fluids until he/she can drink adequately.

Your child will have stitches on the palate where the cleft was repaired. The stitches will dissolve after several days and they do not have to be taken out by the physician. In some cases, packing will be placed on the palate. Do not take the packing out unless you are told to do so by your child’s physician.

There may be some bloody drainage coming from the nose and mouth that will lessen over the first day.

There will be some swelling at the surgery site, which will diminish substantially in a week.

For two to three days, your child will feel mild pain that can be relieved by a non-aspirin pain medication. A prescription medication may also be given for use at home.

Many infants show signs of nasal congestion after surgery. These signs may include nasal snorting, mouth breathing, and decreased appetite. Your child’s physician may prescribe medication to relieve the nasal congestion.

Your child will be on antibiotics to prevent infection while in the hospital. Your child’s physician may want you to continue this at home.

When To Call The Doctor

  • Fever over 101°F when taken rectally, axillary or in the ear.
  • Pain that does not go away when you give pain medicine.
  • Any injury to the incision or any bleeding in the mouth.
  • Trouble drinking or eating.
  • A dry diaper for 8 hours or more.
  • Taken too much medicine or the wrong medicine. Call the Central Ohio Poison Center at 222-1222, TTY 688-0088. They will tell you what to do.

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Facial Reconstruction Surgery And Cleft Palate Repair

Cleft palate repair, also known as cleft palate surgery, is a facial reconstruction surgery performed by a reconstructive surgeon that specializes in the intricacies and complexities of facial reconstructive surgery. For decades, Dr. Peter Grossman of Grossman Medical in Los Angeles County has been known as the leading expert for facial reconstruction surgery with cleft palate repair being one of the most common procedures performed on adults and children. Typically, cleft palate repair and other birth defects of the face requiring facial reconstruction surgery is done when the patient is a small child or an infant. However, there are several reasons why this procedure may be postponed. If you or your child are in need of a facial reconstructive surgeon, be it for cleft palate repair, or for another procedure that focuses on abnormalities of the face, book a consultation at Grossman Medical today.

What Can I Feed My Baby After Surgery

Cleft lip

After repair of the palate, your baby will need to be on a full-liquid diet until the surgeon instructs you to advance to soft foods. Most infants are able to work up to their pre-surgery intake within a few days. Thoughtful meal planning after discharge can help your child get the nutrition needed for wound healing. Here are some tips for doing just that.

Parents, who are concerned about cholesterol and heart health, may be uncertain about adding fats to their infants diets. The full-liquid diet is a temporary method of feeding that boosts calories and provides adequate nutrition children need during recovery.

  • Introducing new foods at this time is not advised, as sensitivities may arise. Wait until you child is fully recovered to try any new foods.

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How Would You Describe Hypernasal Speech

When a person speaks, too much air escapes through their nose, resulting in hypernasal speech. Speechwriters should avoid using certain letters and sounds that could have air escaping through the nose.

In hypernasal speech, air escapes from the nose while talking and contributes to the sound of the voice. The most common cause of this condition is velopharyngeal incompetence or VPI. Obese dachshunds are the most common cause of nose congestion. A speech-language pathologist should examine the child. Instruments for detecting abnormalities in airflow can also be used to aid in diagnosis. In cases of hypernasal speech, an x-ray study is performed to aid in the resolution of the problem area and a specialist in nose and throat is referred to the ear.

What Is Recovery From Cleft Lip Or Cleft Palate Surgery Like

After surgery, babies stay overnight in the hospital, where they’re monitored to make sure they’re breathing and feeding well. A specially designed bottle that optimizes milk flow may be used for feeding for several weeks, because some babies aren’t able to perform suction feeding.

About a week after surgery, the sutures in the lip area are removed. The stitches used for the palate dissolve on their own.

During the years after surgery and throughout childhood, the child’s speech and dental functions will be monitored by specialists to ensure that they’re developing and on track.

Ideally, the child’s face will develop with little or no visible evidence that he or she was born with a cleft lip and/or palate, notes Dr. Steinbacher.

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Hypernasality Speech Therapy Goals

If you need to change the position of your tongue, a speech therapist can help you figure it out. You will gain an additional degree of lower posterior movement of your tongue as a result of this treatment.

An example of hypernasality is when your speech comes out nasally. Hypernasality can be caused by a variety of factors, including misarticulation and physiological abnormalities. Parents with hypernasal children are more likely to seek speech therapy treatment for their children. Adults with disabilities also benefit from speech therapy. It is characterized by a voice that projects from the nose. If you sing your oral consonants or vowels too loudly, you may have nasal resonance. There may also be issues with swallowing.

When someone has hypernasality, the tone of their voice is the most common symptom. It can have an impact on your self-esteem if you or your child have hypernasality, which makes it difficult for others to understand. Speak with us about our speech therapy clinic. Speak with one of our speech therapists today by calling District Speech.

How Long Does Cleft Palate Surgery Last

Cleft Lip Baby Before & After Surgery – Palate Surgery

Cleft palate surgery can take anywhere from two to six hours or more, depending on the repairs needed. Before the surgery starts, an anesthesiologist will give your child medicine to fall asleep, and they will stay in the operating room the entire time to make sure your child feels no pain. Once your child is asleep, a plastic surgeon will make incisions in the palate and rearrange the tissues to close the opening. Normally, no tissue is needed from other parts of the body to complete this procedure. The surgeon will use dissolving stitches to close each layer of tissue and place the muscles in the soft palate in the best position to heal and grow.

Your child may need multiple surgeries to repair the cleft palate completely. If your child also has a cleft lip, it’s often repaired before or during cleft palate surgery. If your child has a cleft in the gum, the surgeon will repair it at a later time. This often occurs around the ages of seven or eight when your child’s upper jaw has had more time to grow. Plus, as your child grows, they might need additional surgery to improve speech function this could include lengthening the soft palate or reducing the opening between the nose and the throat.

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What Are The Benefits Of Cleft Lip And Cleft Palate Surgery

Surgery to correct a cleft lip or palate helps your childs lips and mouth function properly and lowers the risk of certain health conditions. A child with a cleft lip or cleft palate is at risk for:

  • Frequent ear infections or fluid buildup behind their eardrum.
  • Trouble feeding, sucking or swallowing.
  • Fluid coming out of their nose.
  • Surgery isnt successful or more surgeries are needed.

History Of The Procedure

Rogers and Georgiade expertly reviewed the evolution of cleft palate surgery. The first record of a palatal operation dates to 500 AD and was prompted by inflammation of the uvula. In 1552, Houlier proposed suturing palatal clefts and 12 years later Ambroise Pare illustrated obturators for palatal perforations. In 1764, Le Monnier, a French dentist, successfully repaired a cleft velum with a few sutures and hot cautery of the edges. von Graefe, 50 years later, produced inflammation of the velar margins before bringing them together in his palate suture and is credited with performing the first velar repair of a cleft in 1816. JC Warren performed the first velar closure in America in 1824.

In 1828, Dieffenbach enhanced the surgical treatment of cleft palate by introducing hard palatal mucosa elevation to allow the closure of hard palatal cleft. von Langenbeck proposed the creation of a bipedicle mucoperiosteal flap that can be mobilized medially to close the palatal cleft. The improved vascular supply of the mucoperiosteal flap significantly decreased the incidence of dehiscence. See the image below.

Much discussion has centered over the role and timing of presurgical appliances. Both the hard palate and the alveolus can be molded with passive molds and active devices, with the shared ultimate goals of facilitating surgical repair and providing an improved long-term outcome in both facial form and palatal function.

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Palatoplasty Cleft Palate Repair Surgery

Timing of cleft palate repair surgery , is generally performed between 9 to 12 months of age. Children with cleft palates are able to feed and gain weight, even without repair. The most frequent issues that result from a cleft palate relate to speech, hearing, and facial growth. The main goal of palatoplasty is to restore the ability to produce normal speech. Normal speech requires the nasal airway to close off from the oral airway during certain speech sounds, including vowel sounds and consonant sounds such as p, b, g, t, and d. Several structures, including the soft palate , lateral pharyngeal walls , and posterior pharyngeal wall , must come together to allow for this velopharyngeal closure. When the velopharyngeal sphincter closes improperly during speech, air escapes through the nose instead of the mouth. This is known as velopharyngeal insufficiency, or VPI. Children with cleft palates may have gaps in the hard and/or soft palates, which allow air to escape through the nose during speech. In addition, the muscles of the soft palate are oriented so that they are unable to move the soft palate sufficiently. Early surgery on the palate may affect the growth of the maxilla, or upper jaw. For this reason, we wait until the time of the usual production of speech before performing palatoplasty. The larger size of the tissues at this time also ensures a more accurate repair.

How Is A Cleft Palate Repaired

Before &  After Cleft Lip &  Palate

The repair of a cleft palate requires cleft palate reconstructive surgery and general anesthesia. The cleft is repaired by bringing the tissues around the cleft together. There is no need for artificial materials or bone grafts in order to repair the palate .

Fig. 5 Cleft palate before and after repair.

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What Does Recovery Time Look Like For Cleft Palate Repair

Most people who see a facial reconstructive surgeon for cleft palate repair stay in the hospital for one to three days. Several external factors related to your health will dictate the amount of time you require hospitalization. Discomfort after the surgery is normal, but Dr. Grossman will prescribe some pain management medication to keep patients comfortable. Antibiotics will also likely be prescribed.

After the first few days of having cleft palate repair surgery, you may see specks of blood in your mucus or saliva for a few days, and the saliva could appear to be pink. You may also experience some clear drainage coming from the nose for a few weeks after the surgery since the opening between the nose and thr mouth has been closed. You may also sound congested for a few weeks, and possibly even start snoring, but this will go away as you have less drainage to deal with and your swelling subsides. In some cases, it can be harder for people to fall asleep after cleft palate repair, but your doctor will be able to help you with this problem, should it surface. Finally, your appetite may become reduced. Protein shakes are great sources of nutrition if you dont feel like eating normal foods and be sure to stay hydrated.

Finally, most patients who receive cleft palate repair will make a full recovery in roughly three weeks, but once you have a consultation with Dr. Grossman, you will have a much clearer and more accurate idea of your recovery time.

Could We Just Wait To Start Solids Until After The Surgery

Some parents delay introducing solids until after palate repair. We discourage this for three reasons:

  • Your child may miss out on the opportunity to develop oral skills that are needed for speech development.
  • To ensure adequate nutrition for growing infants, the American Academy of Pediatrics recommends introducing solid foods between 4-6 months of age.
  • When preparing for palate surgery, your child will benefit from solid foods that are a good source of calories and fluids.
  • To promote normal growth and development in infants with cleft palate its best to follow the same feeding guidelines recommended for infants without clefts.

    Remember if you introduce solid foods before surgery, your child will get used to eating them. Following surgery, you can offer favorite solid foods to help ensure adequate nutrition during recovery. Post-op, some infants even prefer solids, especially if they dont like taking fluids from a cup. In addition, because solid foods provide additional calories that are metabolized more slowly, your child may be able to eat less frequently.

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    Treatment Options Available For Children With Resonance Disorders

    Children with cleft palate are prone to having a resonance disorder, which causes them to be unable to understand what they are saying. The most common cause of a resonance disorder is hypernasality , which can be caused by a number of factors, including a cleft palate or submucous cleft palate. Other possible causes include a short soft palate, Craniofacial abnormalities, adenoidectomy, an enlarged or irregular shaped adenoid, mislearning, muscle weakness, velar paralysis, or neurological disorders. You may be concerned about how this condition will affect your childs ability to communicate if he or she has a resonance disorder. However, there are ways to help your child speak more clearly in a more effective manner. If your childs voice is affecting him or her, you should consult with his or her healthcare provider.

    How Is Cleft Palate With Cleft Lip Treated

    Before and After Cleft lip Surgery Baby – Small cleft Surgery Results & Journey

    Cleft lip and cleft palate can cause problems with:

    • ear infections and hearing
    • speech development

    So it’s important to correct a cleft palate with cleft lip with surgery while a child is young.

    Cleft Lip Repair

    A plastic surgeon will repair the baby’s cleft lip first, usually when the baby is about 3 months old. This is done with a surgery called cheiloplasty . It’s done in the hospital while the baby is under general anesthesia.

    The goals of cleft lip repair are to:

    • Close the cleft.
    • Improve the shape and symmetry of the upper lip and nose.

    If the cleft lip is wide, special procedures like lip adhesion or nasal alveolar molding might help bring the parts of the lip closer together and improve the shape of the nose before the cleft lip repair. Cleft lip repair usually leaves a small scar under the nose.

    Cleft Palate Repair

    A cleft palate usually is repaired with surgery called palatoplasty when the baby is 1012 months old. The goals of palatoplasty are to:

    • Close the opening between the nose and mouth.
    • Help create a palate that works well for speech.
    • Prevent food and liquid from leaking out of the nose.

    In palate repair surgery, a plastic surgeon will:

    • Close the cleft in layers.
    • Rearrange and repair the muscles of the soft palate so they work better during speech.
    • Make two incisions on each side of the palate behind the gums to ease tension on the palate repair.

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