Question

A female infant has just been born. Prenatal sonograms had shown the existence of cheiloschisis, but her parents seem to be horrified by her actual appearance.

1. What is cheiloschisis?

2. What supportive assistance can be provided to the parents?

3. Will a surgical procedure be immediately performed on the infant?

4. What is the long-term expected outcome of the surgical procedure for the infant?

5. Describe the most commonly used technique for performing a cheiloplasty referred to as the rotation advancement.

Answer 1

1.Cheiloschisis is a birth defect.  Cheiloschisis means Openings or splits in the roof of the mouth and lip.

It is also called Cleft palate and is a common birth condition. It can happen alone or can be a part of a genetic condition or syndrome.

2. Supportive assistance to the parents:

•Give them some counseling and educate them.

Be patient with them and make them understand that it is a common thing and it can be healed by surgery.

Start by answering their questions and doubts about this. Give them clear answers.

Also give them confidence that it can be healed up to an extent.

• Provide them with books written for parents of children with birth defects.
• Also make them contact support groups or other parents.

3.No,in most cases cleft lip repair is done when the infant is 3 to 6 months old.

And cleft palate repair is done when the child is older(9 months to 1 year).

4.Totally 68.8% cases of cleft lip and palate repair had good outcomes; 67.9% of lip repairs had good lip and nose scores, and 70.2% of palatal repair had a good surgical outcome. Oro-fistula was observed in 29.8% of cleft palate repairs Inter-rater reliability coefficient was substantially significant.

•Lip closure will have a strong effect in the anterior alveolar region.

Some things to note after surgery include:

Dental concerns: One of the common issue could be dental problems, such as missing, extra or malpositioned teeth. Almost all children with a cleft palate will need braces on their permanent teeth. Also, eruption of the permanent teeth is often delayed.

• Speech problems:  25 to 35 percent of children will need speech therapy after surgery.
• Nasal and septum deformities: There can be some deformities of the nose and septum before surgery and will be helaed to the best possible way.

5.Millard, in 1955,developed the concept of rotation-advancement flap to treat cleft lip, which has became the most popular technique worldwide. The procedure involves lateral flap advancement into the upper lip combined with downward rotation of the medial segment, preserving the philtrum.

Someimportant things he added is: 1) the rotation incision must be radical and extend just past the midline to allow adequate drop of the Cupid’s bow component A; (2) advancement of flap B from the lateral lip element in severe clefts requires tension which Can be hazardous in the newborn whereas at two to three months of age this tension becomes a minor concern; (3) criticism of this technique has been aimed at the long oblique scar. Actually, the scar disappears into the philtrum line; (4) approximation of the vermillion, with or without interdigitating flaps, usually calls for a minor trimming or revision after six months to perfect symmetry of the free edge of the bow; (5) medial advancement of the lateral lip flap B with lateral advancement of little flap C achieves a striking nasal correction even in severely distorted noses; and (6) absolute minimal discard of tissue