Early closure of cleft lip and palate

Abstract

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