Correct time and sequence for closure of cleft lip and palate

Abstract

1. 1. Always be seated to correct cleft lips and palates. 2. 2. Seasons of the year bear no influence on the optimum time for operation. 3. 3. Child's and parents' future happiness is made or broken by surgery. 4. 4. Baby is not to be operated upon before one or two weeks of age; it is not an emergency. 5. 5. Lip is to be closed first, as a rule, at about two weeks of age. 6. 6. Palate is to be closed in three to six months. 7. 7. The baby is placed in Trendelenburg position for operation. 8. 8. There may be lack of development of upper jaw in some cases. A denture or orthodontia will compensate for this lack of development. 9. 9. Many serious conditions develop if the palate is closed at two years or older. 10. 10. Early closure of palate, at three to six months, will prevent the abnormalities of development. 11. 11. Early closure of palate is a “must” when a child has an associated otitis media or a micrognathia. 12. 12. Indications and contraindications for the wearing of a prosthetic appliance are as follows: Denture indicated when: ( a) a cleft cannot be closed surgically; ( b) to close the nasopharyngeal space; ( c) to restore vertical dimension; ( d) to restore anteroposterior dimension; ( e) to restore lateral dimension; ( f) to restore occlusal plane. Denture contraindications in: ( a) case that can be corrected by orthodontia; ( b) case that can be corrected by bridgework; ( c) case that can be corrected by exercise; ( d) any case that has a possible chance of developing normally. 13. 13. Failure of palatal healing is not due to infection but to tension and destruction of blood supply. 14. 14. Suggestions for facilitating technic of early closure are as follows: ( a) use of suture in tongue; ( b) use of tongue depressor and elevator, “tongue controller”; ( c) use of catheter and wire for anesthetic in bilateral cleft lip cases; ( d) use of aspirator instead of sponge; ( e) use of smallest atraumatic needle and suture; ( f) cutting sutures short on the knot or 1 mm. long; ( g) leaving tongue suture in until baby is fully conscious; ( h) administration of fluids and food as soon as tolerated; ( i) penicillin routine for first week; ( j) sedation, as required; ( k) use of indwelling catheter for one or two weeks for food; ( l) no restraining of baby for inspection of palate postoperatively; ( m) availability of aspirator in room at all times; ( n) straight arm restraints of elbows during healing period to prevent fingers from getting into the mouth; and ( o) feeding with ear syringe, medicine glass, teaspoon or plastic cup with cover and spout.