Secondary Deformities of Cleft Lip Nose
Cleft lip and palate is relatively common congenital anomalies. The incidence in Asian population is 1.2 to 1.5 cases in every 1000 live births. Cleft lip can occurs in isolation or in combination with the presence of cleft palate. In some cases, cleft palate can occurs alone without cleft lip. In a smaller number of patients, cleft lip and palate are part of a syndromic condition with various other abnormalities in other parts of the body. Cleft and and cleft palate can occur on either side of the lip or in some cases occur in both sides.
Because of the location of the anomaly, cleft lip and palate can affect various structures. These include the upper lip, the hard and soft palate, the nose, the dentition, the maxillary bone and indirectly the mandible and the middle ear. Potential functional disturbances resulting from cleft lip and palate are feeding, speech development, hearing, teeth and dental function. There may also be psychological problems result from the external appearance of the patient.
Management of cleft lip and palate is complex and long-term, involving doctors from various disciplines. It requires patience and long-term commitment from both the parents and doctors. The plastic surgeon usually repair the cleft lip at the age of 3 months. This is followed by palate repair at the age of 6 to 9 months before the speech starts to develop. Depends on the severity, nose repair may need to be performed as well during the lip repair. ENT referral is made to assess the middle ear. If there is speech impairment, then the patient will be referred to a speech therapist for the speech problem. The patient will be followed up continuously. If there in cleft in the alveolar bone, alveolar bone graft will be performed at the age of 9 to 12 years old. Problem of teeth alignment will require orthodontic treatment. In cases with significant malocclusion, orthognathic surgery will be required to realign the malpositioned maxilla and mandible. Secondary rhinoplasty and lip revision may be performed in the late adolescence or early twenties to improve the external appearance of the nose and lip.