The Difference Normal Lips & Cleft Lips20 December 2017
THE NORMAL LIP
The accompanying diagrams demonstrate the areas usually discussed during cleft management. These terms may seem strange but they will help you understand what is being discussed by specialists at clinics when you attend.
The lip has three layers, skin, muscle and the lining inside the mouth (mucosa). The lip has several anatomical features which will be often referred to by the Surgeon when talking about planning and the result of surgery.
The palate consists of a hard palate which is the solid base for the teeth of the upper jaw, and a soft palate which is muscular and mobile. It is the soft palate which is so important in both speech and in preventing the escape of air and food from the mouth into the nose. The uvula hangs down from the soft palate and helps the palate form a good seal between the mouth and nose. Both the soft and hard palates are made up of three layers. There is an oral (mouth) layer, a bone and muscle layer and a nasal (nose) layer. The hard palate has bone in the middle layer and the soft palate has muscle in the middle layer. There are five different groups of muscles all of which are involved in speech and all of which are affected by a cleft palate.
The nose is a complex structure consisting of skin and cartilage (gristle) on a bony framework. The ala is often collapsed on the side of a cleft lip and the columella is often pulled to the opposite side of the cleft. The septum (the gristle separating the two nostrils inside the nose) is often displaced into one or other nostril causing difficulty in breathing on that side.
CLEFT LIP & PALATE
Types of Cleft and Problem faced
The incidence of cleft lip and palate is approximately l in 800 live births in Ireland. The commonest form presenting to our unit is a cleft of the palate alone. The next most common form is a one sided complete cleft of the lip and palate and the rarest form is a bilateral (double) cleft lip and palate.
The following diagrams show:
- An incomplete cleft lip which often affects the shape of the nostril and is sometimes associated with a notch in the gum (alveolus). A baby with this will require repair of the lip and may later need surgery to improve the nose and orthodontics when the adult teeth appear.
- A complete cleft lip which will involve the palate and the lip. This baby will require a lip repair, a palate repair, a bone graft to the gum (alveolar bone grafting) and possible late revisions of the lip and nose to improve appearance and even surgery for speech improvement. The full team involving Speech and Language Therapists, Ear Specialist, Orthodontist and Maxillo-Facial Surgeon will be required.
- A bilateral complete cleft lip and palate is a major defect but one for which much can now be done. Only very rarely is the palate not involved. Usually the middle section of the lip, being unattached at both sides, becomes very prominent and the appearance is upsetting for all concerned. However, once the lip is repaired this appearance is much improved. Sometimes if this middle section (the premaxilla) is too prominent to allow the lip repair it may be necessary to use special braces and tapes to mould it into a more favourable position. This is done by an orthodontist and is called presurgical orthopedics. The principles of treatment are otherwise as for the complete one sided cleft lip (B above).
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