Cleft Lip Surgery
Cleft lip and cleft palate are the commonest congenital deformities with which the plastic surgeon is concerned. It is estimated that such deformities occur once in every 770 live births. While the cause is uncertain, evidence suggests that cleft of the lip, with or without cleft of the palate, is strongly influenced by heredity. On the other hand, isolated cleft palate without cleft of the lip may be related to intrauterine influences, such as maternal anemia, febrile illness, or chronic disease, during the early weeks of pregnancy. Isolated clefts of the palate have been produced in animals by maternal vitamin deficiencies, anoxia, or administration of cortisone.
Surgical repair of the cleft lip and primary reshaping of the nose are done early in infancy. Since a number of older methods have been supplanted by the contributions of modern skilled plastic surgeons, the infant now born with a cleft of the lip can hope to have the deformity corrected so expertly that there will be inconspicuous scars and minimal distortion of the features. The cleft palate is seldom repaired during the first year of life because there are significant risks and because speech, the major reason for its repair, develops later. In the United States there is a prevailing opinion that the operation should be done between the first and second years. The child, who is developing normally in every other respect, can then learn to speak with an intact roof of the mouth. The plastic surgeon hopes that correct speech habits will develop after the closure of the cleft and that speech will not have to be relearned, but special speech training may be necessary even after early repair.
The surprising predominance of clefts on the left side of the lip is unexplained. Clefts occur on the left side twice as often as on the right, and those of both sides of the lip occur with the same frequency as those on the right. The fundamental embryological deficiency in clefts of the lip and palate is one of lack of mesodermal tissue, from which the bony framework, muscle, and connective tissue of the face arise.
When clefts involve the ridge of jaw on either side containing the tooth sockets (alveolar process), deficiencies usually occur in the dental development of the jaw. Teeth may be missing, may erupt abnormally, or may have insufficient support. The dental prosthodontist (builder of dental plates) or the orthodontist (straightener of crooked teeth) may then be called upon to help complete the functional and cosmetic restoration of the mouth. Occasionally, the relationship of the upper and lower jaws may be sufficiently abnormal to require repositioning of the whole arch containing the teeth on both sides of the jaw.