What is a cleft Lip and Palate?

Lips and palates develop from separate parts during the first 3 months of pregnancy. Normally, the left and right parts of the lip come together or "Fuse" creating a normal lip. The two vertical lines on the normal upper lip are created when the left and right parts fuse. In a similar way, the left and right parts of the palate come together to create a normal palate. A front-to-back line along the roof of the mouth can usually be seen where the joining has occurred.

A cleft lip is a defect in the lip where the two parts from which the lip develops have failed to fuse. A cleft palate is a similar defect in the roof of the mouth where the two parts from which the palate develops have failed to fuse.

What are the Craniofacial Abnormalities?

Craniofacial abnormalities are defects or deformities involving the face and the skull. These abnormalities occur when the growth of skull and facial bones is affected leading to deformation of shape of the head and the face. Long facial clefts can also occur involving the lip, cheek, eyelids and facial bone leading to sever facial disfigurement. Some of these abnormalities may involve eye or ear resulting in misshapen or absent organ. Each abnormality needs to be evaluated individually and treated accordingly.

Craniosynostosis is another common abnormality which includes the skull bone. There is a defect in the growth of one or more skull bones leading to deformation of the skull which also affects the shape of face. Occasionally these deformities lead to increase in tension in fluid spaces of the brain and may affect the growth of the brain. It can also damage the vision. Many children form more complex deformities.

The common soft tumours of the craniofacial area are vascular malformation, neurofibroma and other facial bone tumours. These tumours can extensively involve the facial structures and facial bone. They may need extensive resection and major surgery.

How to feed Cleft Babies?

There is no best method to feed your baby. It is often necessary to try several methods before deciding which one is best for both mother and child. Quite often food comes down the nose during feeding. This is nothing to be too concerned about. Simply wipe it away and continue feeding. Children with only cleft lip will able to such without much problem. However, children with cleft palate will have a problem with sucking.

However feeding needs patience and efforts from mother and baby. Breast feeding is best, but the majority of babies are not able to suck enough. If the child is not able to suck, the breast milk should be extracted by a breast pump and given by bottle or spoon.

Bottle feeding is good if good hygiene and sterility of the bottle and teat is ensured. If not, spoon feeding is a good method. Both methods are best used with the baby in a fairly upright posture, resting on the mother's arm. This posture reduces the amount of milk passing up into the back of the nose. For bottle feeding, enlarging the hole in the teat allows milk to flow more freely and avoids the baby having to work hard. Milk should flow out of the bottle when it is turned upside down. Alternatively, a soft squeezy bottle can deliver milk at a rate that matches the ability of the baby to swallow.

By far the greatest problem with feeding is wind. Because babies have difficulty sealing their mouths around the teat, they tend to swallow a lot of air while feeding. To help reduce this tendency, hold the baby more upright while feeding and ensure the milk is delivered to the back of the mouth, so it can be swallowed easily. You will need to burp your baby frequently during the feed, and most importantly, make sure the baby has no air at the end of the feed, before being put down to sleep.

The feedings should be given about every 3 hours to start a pattern. If the feedings are longer apart than that, the baby may get too hungry, and may not feed well. The feedings should take anywhere from 20 - 40 minutes. If it takes longer than this, the baby may be working too hard. Try enlarging the hole in the teat. On an average, the child needs 2-3 ounces/pound/day of milk.

Other liquid diet, semisolid and solids are started like in a normal baby. Some solid or liquid food will regurgitate through the nose, but this is nothing to worry about. This will stop after palate repair. Follow the instructions of the doctors for the postoperative feeding.

Will the child be normal after treatment?

The aim of treating children with cleft lip and/or palate is to achieve normal looking and normal sounding well adjusted individuals. The cleft child is likely to have the best possible result in achieving this aim if treated by an organized, well trained multidisciplinary team. When treated at the proper age, normally they have good results. They will be like normal children except a small scar on the lip and will need supervision until adolescence. In addition they might need appropriate intervention by the Plastic Surgeon, the Dentist, the ENT surgeon and the Speech Therapist at appropriate intervals according to individual needs during childhood and adolescence.

How much do the Operations cost?

Normally the cost of these operations would run into several million rupiah for each surgery. However several cleft operations through Yayasan Senyum Bali are sponsored by a non profit organization called ‘Smile Train'. Poor patients who cannot afford surgery can be operated completely free of cost under the Smile Train project.

In the case of other Craniofacial deformities (other than Cleft Lip & Palate), the cost of each surgeries are vary depending on each case. Please email us for more detail information.