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A cleft is a fissure or opening. It is the non-fusion of the body’s natural structures that form before birth, usually between 6 and 12 week of foetal life, i.e. 2nd and 3rd month of pregnancy. A cleft may affect the lip, the palate or both the lip and the palate.

Types of clefts:

  • cleft soft palate and the split of uvula
  • cleft hard and soft palate (incomplete or complete)
  • cleft soft and hard palate with cleft lip and alveolar process (unilateral or bilateral)
  • cleft lip and alveolar process (unilateral or bilateral)
  • cleft lip (unilateral or bilateral)

The causes of the cleft have not been completely identified yet. It is said that there are genetic factors that contribute to cleft lip and palate formation, although the tendency to inherit this defect grows only when certain environmental circumstances occur such as: vitamin A, folic acid, pantothenic acid and nicotinic acid deficiency or vitamin A surplus, malnutrition, oxygen deficiency, corticosteroids (released due to a chronic stress), irradiation, decline of the volume of the amniotic fluid or viral infections.

Approximately 1 in 500 to 700 children born in Europe have a cleft lip. Each year in Poland 800 children with that developmental disorder are born.

The treatment of clefts is based on restoring the body’s natural structures and stimulation (with the help of a step-by-step rehabilitation) of the face muscles to further consonant development.

Our team of doctors is able to exactly determine, which of the tissues require reconstruction and rehabilitation in order to restore their proper functioning. The professional care of the child is taken by a surgeon, orthodontist and speech therapist and if necessary by other specialist. The therapy of a child with cleft defect requires multiple procedures and takes time, but if carried out skilfully it enables complete healing.

Remember: cleft lip and palate is not a life long problem of any kind! It is just as a stage of life which doesn’t have to determine it!

We always emphasize that in order to achieve success with the treatment and rehabilitation, knowledge, experience and cooperation of a number of specialists are crucial.

Now such professional help you will find all in one place in Formmed.

Here are the specialists who in our facility are engaged in cleft lip and palate treatment:

SURGEON / MAXILLOFACIAL Surgeon

Due to the open connection between the oral cavity and nasal cavity the treatment of a child with the cleft defect starts with the surgical fusion of soft tissue of the nasal and mouth cavity.

The operation is essential for the further, correct development of your child!

During the first visit, usually around 4-6 weeks of age, the surgeon gives all the information about the preparation of the child for the procedure. He schedules the date of the first operation as well as he discusses the surgical treatments to follow. See the paragraph: Procedures schedule.

Each of the surgical procedures is a huge experience both for the child and its parents. Adults should though take control over their emotions since the child feels their anxiety, loses the feeling of security and therefore experiences additional stress, which influences the process of healing.

The surgical procedure is always a strain for the body. It should be remembered though that the child is left only with a postoperative wound in the mouth while his or her body and all the tracts he uses for the wound to heal faster are healthy.

Currently our team uses methods which enable cutting down the time and number of surgical procedures to 2 or 3 in children with complete cleft lip and palate. All the operations are done in preschool age children.

Consecutive visits at the surgeon’s have a follow up character and are connected with consultations with other specialists, according to the schedule of the child’s health checkups. Usually those take place at the age of 3, 5-6, 10, 15 and 18. Such visits include consultation with specialists, taking a photograph, recording the speech and mimics with a video camera. Such documentation shows the course of the treatment and its final effect. It is a proof of effectiveness of the therapeutic actions taken by our team. At the same time it enables fast reaction whenever any anomalies occur, because it has to be remembered that to existing congenital disorders some genetic conditions may additionally occur.

SPEECH THERAPY

A baby with a cleft disorder should as fast as possible be referred to a speech therapist. In Formmed the parents together with the child are directed to that specialist already before the first surgical procedure. First meetings consist mostly of a detailed interview with the parents. Important information is e.g. that concerning labor, feeding and the way of laying the baby in bed. It gives initial picture of skills of the little patient. In a direct examination the speech therapist assesses the sensitivity of the face towards stimuli. In children born via c-section an oversensitivity of the face may occur. Including massages done in a cosy atmosphere becomes of great importance, because it makes the future therapeutic procedures less stressful for the baby. During the first visit it is necessary to assess the structure of the speech organs. Here – apart from the obvious anomaly as cleft – it is important to assess the fitness of lips, the length of the frenulum of tongue and of lip. While the frenulum of the upper lip does not raise concern even if it’s short (often its shortening is recommended by orthodontists), the frenulum of tongue requires precise assessment, because it determines the correct functioning of the tongue in the process of articulation. In the event of finding any deviation from the normal state, the speech therapist advises parents on the application of stimulation procedures and systematic rehabilitation exercises depending on the needs of child.

Between the operation and the consecutive visit at speech therapist at least 6 weeks should pass. It is the time when the postoperative wound heals and the child gets used to new anatomic conditions in its oral cave.

Regularity brings good results!

In the initial period after the operation logopaedic consultations should take place at least once a month. It is the most intensive developmental period and simultaneously the best time for preparing the child to master such difficult skills as speaking.

ORTHODONTIST

With the help of various braces the orthodontist corrects anomalies appearing during shaping of dental occlusion in children with cleft defects. The orthodontist prepares the patients for coming up operations (early and late transplant of the bone to the alveolar process and possible other operations of the jaw bone).

At our facility also adults with cleft deformations will find help.

The timing of surgical repair of cleft palate remains controversial. There is though a tendency in the world to shorten the timing of the surgical treatment. Therefore in Formmed following schedule is used:

  • ca. 6 months of age, the continuity of soft tissues is being re-established,
  • ca. 2-3 years of age, based on the arrangement and the conditions of the orthodontic treatment a schedule of the transplantation of the bone to the alveolar process is set, i.e. reestablishment of the continuity of the jaw skeleton,
  • ca. 4-5 years of age is the time of the check of the permeability of the nose and possible septoplasty (correction of the nasal septum deviation).

During the last two operations we do some minor cosmetic procedures so that the child, who starts school or play school, does not suffer from prying eyes.

FEEDING

In case that the parents have problems with feeding the baby, they should as quickly as possible contact a specialist facility which treats facial cleft defects.

In Formmed the parents receive information concerning child care as well as a training of safe feeding of the child depending on the extent of the defect.

The primal activities of an infant are breathing and eating. Due to the fact that in children with cleft defects breathing and intake of food has a common tract, the mother should take care of the hygiene of the oral and nasal cavity. Gentle cleaning of the nasal cavity, done before the feeding begins, enables the child to breathe freely while eating.

The food intake in children with cleft defect is the more difficult the bigger the scope of the defect is. Surely the mother of the baby with cleft lip and palate will not be able to breast-feed. Due to the open connection between the nasal and oral cavity the infant is unable to feed despite the preserved sucking reflex. The cause of this is the inability to create a vacuum necessary to suck out the milk.

Currently there are various types of nipples and special bottles that make feeding of such babies much easier. The choice of the nipple depends on the scope of the defect – for children with large cleft palate a right nipple will be such that is wide and big, which would close the gap of the cleft during feeding; in unilateral clefts more comfortable may be a nipple which is long and narrow.

It is important that the milk flows out of the tilted bottle in big drops and that the baby is laid almost vertically, only slightly slantwise. The baby should be observed whether it swallows the milk and does not choke.

The bottle with milk should be held slantwise and as the amount of milk in the bottle decreases, it should be put vertically so that the child does not swallow the air. If during feeding the milk goes out through the nose the feeding should be paused, the nipple should be taken out of the mouth and you should wait for the child to swallow all the milk that is still present in the mouth.

In infants who do not suck efficiently it is advised to slowly dose the milk, pressing the nipple or the bottle (if it is soft enough) with fingers. In most difficult cases a feeding with syringe or a feeding tube can be implemented.

After feeding the child should be kept in a vertical position until it burps. Only then the baby can be put back into its bed.

APPLICATION OF DUMMIES AND SO CALLED PACIFIERS

Dummies of that type are not usually recommended both by the speech therapists and orthodontists, because they influence the dental occlusion disadvantageously and they contribute to the incorrect functioning of the tongue. Often though it turns out that the infant has such a big need of sucking (and most of the children with cleft defect are not breast-fed) then the dummy becomes the only soothing tool. In such situation a child can be given a dummy, but it has to be remembered that it cannot be present in mouth at all times.