Cleft lip and cleft palate are facial and oral malformations that occur very early in pregnancy, while the baby is developing inside the mother. Clefting results when there is not enough tissue in the mouth or lip area, and the tissue that is available does not join together properly.

A cleft lip is a physical split or separation of the two sides of the upper lip and appears as a narrow opening or gap in the skin of the upper lip. This separation often extends beyond the base of the nose and includes the bones of the upper jaw and/or upper gum.

A cleft palate is a split or opening in the roof of the mouth. A cleft palate can involve the hard palate (the bony front portion of the roof of the mouth), and/or the soft palate (the soft back portion of the roof of the mouth).

Cleft lip and cleft palate can occur on one or both sides of the mouth. Because the lip and the palate develop separately, it is possible to have a cleft lip without a cleft palate, a cleft palate without a cleft lip, or both together.

Having a baby born with a cleft can be upsetting, but cleft lip and cleft palate can be corrected. In most babies, a series of surgeries can restore normal function and achieve a more normal appearance with minimal scarring.

Preparing for surgery

You will begin to prepare your child for surgery 2 weeks before the scheduled date. Starting 2 weeks before surgery, do not give aspirin or ibuprofen (such as Motrin or Advil). These medicines may cause bleeding problems after a cleft palate repair.

A nurse from the operating room (OR) may call you up to a week before surgery to review your child’s health history. You will be asked detailed questions about your child’s current health, recent illnesses, allergies, past surgeries, medicines, and immunizations. It is important to know if he or she has been exposed to any contagious diseases, including the flu or chickenpox, in the last month. Tell the nurse if your child’s immunizations are not up to date.

The day before surgery:

A nurse from the or will call you to give you the following information:

. The time of surgery.

. The time to arrive at the hospital and directions to the Surgery Unit entrance.

. Food and drink instructions. It is very important to follow these exactly.

  . Your child may have breast milk up to 4 hours and formula up to 6 hours before surgery. All other liquids, semi-liquids and solid foods must be stopped 8 hours before surgery.

  . Your child may have clear liquids up to 2 hours before surgery. After that, he may have nothing else to drink. Clear liquids are those you can see through that have no pulp or food bits in them. Examples of clear liquids are water, apple juice and white grape juice.

. Prescription medicines. Give your child his usual prescription medicines, unless the doctor has told you to stop certain ones before surgery. Give medicine with a very small sip of plain water or formula. If your child is due to take his medicine during the surgery, give it before you come to the hospital. If you have questions about medicine, please ask the nurse who calls you.

The nurse will again ask you questions about your child’s health, such as:

. Recent exposures to contagious diseases

. A list of medicines your child is taking

. Anything about your child’s health that the doctors and nurses need to know to care for the child.

Read more about : Cat eye surgey

Read more about : Forehead reduction surgery

Read more about : Liposuction in Iran

The day of surgery

. Give your child a bath before coming to the hospital.

. Pack a few favorite toys. Please label all items with his name.

. The nurse will review your child’s medical history one more time.

. Your child will be weighed and measured. He will have his blood pressure and temperature checked. He will have a physical exam.

. The Cleft Palate Team of specialists will meet you before and after the surgery.

. A nurse will explain special care routines, procedures, and home care to you.

. Parents must wear their pink/yellow badges at all times. Visitors must go to the information desk and get a blue visitor’s pass.

. Children under 12 are not allowed to visit the patient units. This helps reduce the risk of infection to our patients.

Symptoms

Usually, a split (cleft) in the lip or palate is immediately identifiable at birth. Cleft lip and cleft palate may appear as:

. A split in the lip and roof of the mouth (palate) that affects one or both sides of the face

. A split in the lip that appears as only a small notch in the lip or extends from the lip through the upper gum and palate into the bottom of the nose

. A split in the roof of the mouth that doesn’t affect the appearance of the face

Less commonly, a cleft occurs only in the muscles of the soft palate (submucous cleft palate), which are at the back of the mouth and covered by the mouth’s lining. This type of cleft often goes unnoticed at birth and may not be diagnosed until later when signs develop. Signs and symptoms of submucous cleft palate may include:

. Difficulty with feedings

. Difficulty swallowing, with potential for liquids or foods to come out the nose

. Nasal speaking voice

. Chronic ear infections

Causes

Cleft lip and cleft palate occur when tissues in the baby’s face and mouth don’t fuse properly. Normally, the tissues that make up the lip and palate fuse together in the second and third months of pregnancy. But in babies with cleft lip and cleft palate, the fusion never takes place or occurs only part way, leaving an opening (cleft).

Researchers believe that most cases of cleft lip and cleft palate are caused by an interaction of genetic and environmental factors. In many babies, a definite cause isn’t discovered.

The mother or the father can pass on genes that cause clefting, either alone or as part of a genetic syndrome that includes a cleft lip or cleft palate as one of its signs. In some cases, babies inherit a gene that makes them more likely to develop a cleft, and then an environmental trigger actually causes the cleft to occur.

How are cleft lip and cleft palate diagnosed?

Because clefting causes very obvious physical changes, a cleft lip or cleft palate is easy to diagnose. Prenatal ultrasound can sometimes determine if a cleft exists in an unborn child. If the clefting has not been detected in an ultrasound prior to the baby’s birth, a physical exam of the mouth, nose, and palate confirms the presence of cleft lip or cleft palate after a child’s birth. Sometimes diagnostic testing may be conducted to determine or rule out the presence of other abnormalities.

Risk factors

Several factors may increase the likelihood of a baby developing a cleft lip and cleft palate, including:

. Family history. Parents with a family history of cleft lip or cleft palate face a higher risk of having a baby with a cleft.

. Exposure to certain substances during pregnancy. Cleft lip and cleft palate may be more likely to occur in pregnant women who smoke cigarettes, drink alcohol or take certain medications.

. Having diabetes. There is some evidence that women diagnosed with diabetes before pregnancy may have an increased risk of having a baby with a cleft lip with or without a cleft palate.

. Being obese during pregnancy. There is some evidence that babies born to obese women may have increased risk of cleft lip and palate.

Males are more likely to have a cleft lip with or without cleft palate. Cleft palate without cleft lip is more common in females.

Complications

What problems are associated with Cleft lip and/or palate?

Children with cleft lip with or without cleft palate face a variety of challenges, depending on the type and severity of the cleft.

. Difficulty feeding. One of the most immediate concerns after birth is feeding. While most babies with cleft lip can breast-feed, a cleft palate may make sucking difficult.

. Ear infections and hearing loss. Babies with cleft palate are especially at risk of developing middle ear fluid and hearing loss.

. Dental problems. If the cleft extends through the upper gum, tooth development may be affected.

. Speech difficulties. Because the palate is used in forming sounds, the development of normal speech can be affected by a cleft palate. Speech may sound too nasal.

. Challenges of coping with a medical condition. Children with clefts may face social, emotional and behavioral problems due to differences in appearance and the stress of intensive medical care.

Prevention

After a baby is born with a cleft, parents are understandably concerned about the possibility of having another child with the same condition. While many cases of cleft lip and cleft palate can’t be prevented, consider these steps to increase your understanding or lower your risk:

. Consider genetic counseling. If you have a family history of cleft lip and cleft palate, tell your doctor before you become pregnant. Your doctor may refer you to a genetic counselor who can help determine your risk of having children with cleft lip and cleft palate.

. Take prenatal vitamins. If you’re planning to get pregnant soon, ask your doctor if you should take prenatal vitamins.

. Don’t use tobacco or alcohol. Use of alcohol or tobacco during pregnancy increases the risk of having a baby with a birth defect.

During Cleft Palate Repair

Treatment

The goals of treatment for cleft lip and cleft palate are to improve the child’s ability to eat, speak and hear normally and to achieve a normal facial appearance.

Care for children with cleft lip and cleft palate often involves a team of doctors and experts, including:

. Surgeons who specialize in cleft repair, such as plastic surgeons or ENTs

. Oral surgeons

. Ear, nose and throat doctors (ENTs, also called otorhinolaryngologists)

. Pediatricians

. Pediatric dentists

. Orthodontists

. Nurses

. Auditory or hearing specialists

. Speech therapists

. Genetic counselors

. Social workers

. Psychologists

Treatment involves surgery to repair the defect and therapies to improve any related conditions.

Surgery

Surgery to correct cleft lip and palate is based on your child’s particular situation. Following the initial cleft repair, your doctor may recommend follow-up surgeries to improve speech or improve the appearance of the lip and nose.

Surgeries typically are performed in this order:

. Cleft lip repair — within the first 3 to 6 months of age

. Cleft palate repair — by the age of 12 months, or earlier if possible

. Follow-up surgeries — between age 2 and late teen years

Cleft lip and palate surgery takes place in a hospital. Your child will receive a general anesthetic, so he or she won’t feel pain or be awake during surgery. Several different surgical techniques and procedures are used to repair cleft lip and palate, reconstruct the affected areas, and prevent or treat related complications.

In general, procedures may include:

. Cleft lip repair. To close the separation in the lip, the surgeon makes incisions on both sides of the cleft and creates flaps of tissue. The flaps are then stitched together, including the lip muscles. The repair should create a more normal lip appearance, structure and function. Initial nasal repair, if needed, is usually done at the same time.

. Cleft palate repair. Various procedures may be used to close the separation and rebuild the roof of the mouth (hard and soft palate), depending on your child’s situation. The surgeon makes incisions on both sides of the cleft and repositions the tissue and muscles. The repair is then stitched closed.

. Ear tube surgery. For children with cleft palate, ear tubes may be placed to reduce the risk of chronic ear fluid, which can lead to hearing loss. Ear tube surgery involves placing tiny bobbin-shaped tubes in the eardrum to create an opening to prevent fluid buildup.

. Surgery to reconstruct appearance. Additional surgeries may be needed to improve the appearance of the mouth, lip and nose.

Surgery can significantly improve your child’s appearance, quality of life, and ability to eat, breathe and talk. Possible risks of surgery include bleeding, infection, poor healing, widening or elevation of scars, and temporary or permanent damage to nerves, blood vessels or other structures.

Treatment for complications

Your doctor may recommend additional treatment for complications caused by cleft lip and cleft palate. Examples include:

. Feeding strategies, such as using a special bottle nipple or feeder

. Speech therapy to correct difficulty with speaking

. Orthodontic adjustments to the teeth and bite, such as having braces

. Monitoring by a pediatric dentist for tooth development and oral health from an early age.

. Monitoring and treatment for ear infections, which may include ear tubes

. Hearing aids or other assistive devices for a child with hearing loss

. Therapy with a psychologist to help the child cope with the stress of repeated medical procedures or other concerns.

After Cleft Palate Repair

After Surgery

Some pain is normal after surgery. Your child will be sent home with pain medicine and an antibiotic.

For the first few days after surgery, you may see the following things:

. There may be a small amount of blood in the mucous or saliva (spit) for several days. The mucous or saliva will appear pink.

. More clear drainage than usual may come from the nose (snot) for several weeks. This is because the opening between the nose and mouth is now closed. Before surgery, mucous drained directly into the mouth.

. Your child may snore and sound congested for several weeks. This will go away when the swelling goes down and there is less drainage.

. It may be harder for your child to sleep as well as before surgery. Sleep habits should return to normal after several weeks.

. The appetite may not be as good as it was before surgery. After surgery, it is most important to make sure that your child is drinking enough liquids to stay hydrated.

Recovery

. Depending on the procedure, the recovery takes from 1 to 2 weeks. The baby or the adult patient may expect to see bruises, redness, and light bleeding during this time. Pain and discomfort are also normal.

. In general, the stitches are absorbable and the patients are not required to visit their doctor to remove them. A bandage may be put on the surgical area for a few days following the operation.

. During recovery, the patient should follow the doctor’s instruction. The surgical site must be kept clean. Also, your child is not allowed to put their fingers or hard objects in their mouth for a few weeks if they undergo a palate repair surgery.

Cleft Palate Repair Surgeons

How can I find the best Cleft Palate Repair surgeons in Iran?

Plastic surgeons in Iran can make your face more appealing. It is important that you seek the assistance of experienced and skilled plastic surgeons in Iran who have provided a suitable condition for people with limited budgets to undergo Cleft Palate Repair surgery in Iran easily. It is worth explaining that the quality provided by Iranian surgeons is far higher than other countries including Turkey and India.

Plastic surgeons in Iran, have performed numerous procedures annually which make plastic surgeons in Iran more experienced than other countries’ plastic surgeons, due to high demand and low cost of Cleft Palate Repair surgery in Iran, thousands of people travel to Iran every year so that they can undergo Cleft Palate Repair surgery in Iran with the best plastic surgeons at an affordable and reasonable price.

Plastic surgery hospitals in Iran

Tehran hospitals                                                                            

1. Moheb Kosar Hospital
2. Imam Khomeini Hospital
3. Ebnesina Hospital
4. Parsian Hospital
5. Pasteurno Hospital
6. Kasra Hospital
7. Treata Hospital

Shiraz hospitals

1. Mirhoseini Hospital
2. Ordibehesht Hospital
3. Mir Hospital
4. MRI hospital
5. Dena Hospital
6. Abualisina Hospital
7. Ghadir Mother and Child Hospital

Mashhad hospitals

1. Imam Reza Hospital
2. Mehregan Hospital
3. Hashemi Nezhad Hospital
4. Farabi Hospital
5. Mehr Hospital
6. Sina Hospital
7. Bentolhoda Hospital

Cleft Palate Repair surgery cost in Iran

The cost of Cleft palate surgery in Iran is between $3000- 4000 while the same procedure cost from $5000 to $20000 and more in other countries.