Cleft Lip and Cleft Palate IN INDIA

The defect at birth in a baby is when the mouth part and lip fail to form correctly this condition is cleft lip or palate. There is a possibility of a child developing a cleft palate or lip. A lip cleft occurs if the tissues of the lips fail to join meticulously during the pregnancy. The cleft lip causes an opening in the upper lip. The cut of the cleft lip passes through the lip into the nose. The cavity of the cleft lip can be large or small, and it can be on one or both sides of the lip. You will read in details about cleft lip and palate  surgery, cost, success, recovery etc.

The other name of the mouth cover is the palate. A cleft palate is a disorder in which the tissues of the palate do not join strictly. In the cleft palate, a baby can have a hole in the front or back part of the palate.

A baby can have both cleft lip and cleft palate. A disorder of cleft lip and cleft palate can cause a problem during feeding and talking. The treatment of cleft lip and cleft palate is surgery. Surgery can close the cavity of the lip and the palate.

The best time for cleft lip surgery is before 12 months. The best time for the treatment of cleft palate is before 18 months.

A baby with a cleft lip and palate can have other disorders like dental problems, hearing loss, and ear infections.

Symptoms of the cleft lip and palate

Some common symptoms of cleft lip and palate are the following:

• feeding problems
• speaking problems
• poorly shaped teeth
• a space between the mouth and nose cavity
• the imperfection of the upper jaw

In the cleft lip and palate, a cavity is present at birth time. If a baby has cleft lip and palate, the symptoms can be the following;

• A cleavage in the lips and palate can be on either or both sides of the face.
• The opening of lips can be small or large.
• The space of the cleft lip goes through the lip into the nose.
• In the cleft lip, the appearance of the face does not remain unaffected.
• In the cleft palate, the shape of the face does not change.

In some cases, the cleft occurs in the soft palate (sub mucous cleft palate). The soft palate occurs in the back side of the mouth. Due to the non-physical appearance of the cleft palate, it goes unnoticed at birth. The signs of the sub mucous cleft palate are the following:

• Difficulty in feeding
• swelling
• food comes out of the nose
• nasal speaking voice
• ear infection

Pre-operative instructions for cleft lip and palate surgery

The treatment timing for the cleft lip is 12 months, and for the cleft palate is 18 months of age. The treatment time varies according to the disorder. If the child is not well before the surgery

Some pre-operation procedures for the cleft lip and palate are the following:

What to bring to the hospital? 

• Wearing loose clothes
• Bring a blanket that is comfortable for your child
• Carry your items for a night’s stay
• Feeding equipment for your child
• You should have the information about the child and mother’s health
• nappies (nappies will be available during the admission)

What will happen during the operation

• Do not come to the hospital before the day of surgery.
• Carefully read the admission letter of the hospital.
• Read and follow the instructions and strategies of the hospital.
• There will be a doctor, nursing staff, and anaesthetic to answer the question regarding the health of your child.
• You can stay with your child in the pre-operative area.
• The baby will be in the pre-operative region until the beginning of the operation.
• The duration of the surgery will be 2-5 hours.
• You can stay in the waiting area or cafeteria of the hospital at the time of your child’s surgery.
• After the operation, you can meet your child.

Expectations after the operation

• There will be an intravenous line in the hand of your child.
• A probe is necessary for the hand and foot of the baby to monitor pulse and oxygen saturation.
• There will be a small stent on the nose of the baby to maintain the shape of the nose.
• There can be stitches on the tongue of the child.
• There will be a change in the face of your baby.
• The appearance of your baby will be unique.
• There can be splint on the arms of the baby and tape on the upper lip.

Procedure for the cleft lip and palate treatment

The procedure of the cleft lip and palate treatment will vary according to the type and intensity of the disorder. The time of the treatment method also depends on the child’s health.

Cleft lip repair: 

• There can be more than one surgery for the cleft lip.
• The first surgery occurs at 3-6 months. The first surgery can close the lip of an infant.
• The second surgery occurs after six months of age if necessary.
• There are several techniques to improve the problems of the cleft lip other than surgery. The methodologies are not chronic and can change the shape of the lip, nose, and mouth.
• You can narrow the cavity of the cleft lip with the lip-taping regimen.
• You can correct the shape of the nose with the help of a nasal elevator.
• A nasal-alveolar moulding device helps mould the tissues of the lip into a favourable position.

Cleft palate repair: 

The age of cleft palate treatment is 12 months. A healthy palate does not develop the fluid in the middle ear. To protect the child from fluid development in the middle ear, they need special tubes in the eardrum to help the fluid drainage. The special ducts decrease the hearing problems and need checking once a year.

Some babies need surgeries for the cleft palate to solve their speech problems. A nasopharyngeal scope helps to check the motion of the palate and throat. Surgery to improve speech problems is necessary at the age of 5.

If the baby has a disorder in the gum line, he will need a bone graft that gives permanent support to the teeth and upper jaw.

The additional surgeries are necessary for the following procedures:

• To refine the lip and nose shape
• To close the cavity of the mouth and nose
• To help to breathe easily
• To support and stabilize the teeth and jaw

There can be many possible risks of the surgery, such as bleeding, infection, and damage to tissues and nerves. Usually, the surgery is successful. Sometimes, surgery leaves scars that become less noticeable with time.

Steps of the cleft lip and palate procedure;

There are four steps to cleft lip and palate surgery.

Anaesthesia: 

Anaesthesia is a necessary step for the comfort of your child during the surgical procedure. The anaesthesia can be general or intravenous sedation. Choose the way of anaesthesia that is best for your child.

The incision: 

The cleft lip treatment helps to close an opening in the lip and prepare it for usual functions. The incisions are present on both sides of the disorder. Due to the incision, the skin flaps come together, closing the cavity and reproducing a typical nose and lip structure.

Repairing the cleft palate and carefully repositioning the tissues is necessary to close the hole in the palate. In the cleft palate, an opening is present in the roof of the mouth. Incisions are present on both sides of the palate. In the incision, the reposition of the soft and hard palate occurs. With the help of an incision, a baby can feed, speak, and continue growing in whole life.

Closing the incision: 

An incision helps treat the cleft lip and palate. The moveable or absorbable sutures are necessary to close an incision.

See the results:

Due to surgical procedures, scars are present on the face. The marks become light with time. After the surgery, a baby will grow and function conventionally. The baby does not face the problems of feeding and speaking after the surgery.

Post procedures of the surgery

The instruction that you should follow after the cleft lip and palate surgery are the following:

Pain and medicines: 

After the surgery, there can be mild pain. There will not be much pain when your child is ready to leave the hospital.

The medicines for pain relief are Tylenol or ibuprofen. The time for each medication will be different. A doctor can also suggest pain medicine is Lortab.

Doctors will suggest antibiotics for you. Follow the instructions for antibiotics until all of it is gone.

Diet: 

Your child can restart the food like milk as taken previously. It is okay for your child to renew the feeding after the surgery. If your child has been taking solid food, it is okay to start taking this diet. The food will be very soft and cut into small pieces. Your child can eat soft solids such as overcooked pasta and oatmeal. Do not give hard and crunchy food to your children, such as dry cereal, soft cheese, and peanut butter.

The food will not be hot. Always spoon for feeding. Avoid hard food because it can disrupt the repair.

You can heel your wound with the best nutrition and hydration. Make sure that your child is drinking enough water for proper hydration. Make sure that baby has a wet diaper after every 8 hours.

Wound care: 

There can be a layer of stitches on the upper surface of the lips. You can consult with your doctor if separate surgery is necessary for it. Be careful about the wound. Keep the injury clean and free of crusting. You can clean the nostrils with a washcloth. You can remove the crusts and blood clots with a cloth. Do not apply anything to the lips before discussing scars with the doctor.

Be careful about the nasal stent on the lips. The nasal stent is temporary, and the doctor will remove the nasal stent after three weeks of surgery. You can clean the stent with a washcloth.

Protection of repair: 

Be careful about the roof of the mouth. The palate of your baby’s mouth will be in the healing process after three weeks of surgery. Protect the palate from any injury during the healing process. If there is less feeling in an area of surgery, there is an injury in the palate.

During the healing process, keep all the solid objects away from your child’s reach. A few dense items that can damage the palate of the baby are the following:

• baby toys
• straw
• wooden or plastic toy
• toothbrush
• candy or lollipops
• forks, spoons, and knife
• thermometer
• stick

Activities of your baby: 

Your baby can play as usual, but the baby needs more attention. You can take the Velcro elbow restraints for your baby. The Velcro elbow restraints protect the lip of the baby from rubbing and pulling.

Keep the pacifier away from the baby for three weeks of the healing process. Be careful about feeding the playing items to your baby. Make sure that your baby can not use anything without your approval. During the healing procedure, soft toys are best for the child.

Arm splint:

The baby can or cannot demand an arm splint during the healing procedure of three weeks. Discuss an arm splint with your doctor. Due to support, your baby can not put a finger into the mouth and cannot damage the repair. Take suggestions from the nurse to put the splint carefully.

Mouth care: 

The baby must clean the mouth. To clean the child’s teeth and gums, use a bandage dipped into plain water or a small amount of alcohol-free mouth wash mixed with water.

Use the water after eating to keep the mouth clean. Avoid toothbrushes for three weeks after surgery.

Call your doctor: 

Call your doctor when you feel the following symptoms;

Body temperature more than 101 F.

When the baby does not have relief from pain after taking pain killer

An injury or bleeding from the surgical area

Difficulty in drinking and eating

Period of dry diaper more than eight hours

nausea and vomiting

Swelling and redness in the wound

Risks and complications

The operation for the cleft lip and palate is necessary for your child because, without treatment, the baby can face eating, speaking, and drinking problems. Surgery for cleft lip and palate is essential, but it has many risks and complications. Complications are always present in every surgical procedure.

If you choose a qualified plastic surgeon, the complications after the surgery will be minimum. Discuss with your doctor the complications after the operation. A doctor will guide you to minimize the possible harmful effects of surgery.

After the cleft lip and palate surgery, the biggest problem is Asymmetry. In Asymmetry, both sides of the face don’t match. The purpose of cleft lip surgery is to remove the hole in the upper lip. With the surgery, we can create a usual look and function for the baby’s face. After the cleft lip surgery, there will be symmetry in the nostrils. There will be scars and incisions after the surgery. You can minimize the lesions and other problems with your efforts.

The goal of cleft palate surgery is to close the opening in the roof of the mouth. Due to the cleft palate, different problems occur like eating, drinking, and speaking problems. After the cleft palate surgery, the child can eat and learn to speak accurately. There is no problem with the appearance after the cleft palate operation. After the surgery, there is a possibility that speech development is not usual. The abnormal speech development can lead to secondary surgery of the cleft palate.

The possible risks and complications after cleft lip and palate surgery are the following:

• bleeding
• infection
• risk of anaesthesia
• Poor healing of the wound
• damage to nerves, blood vessels, and muscles
• irregular healing of lesions
• allergies due to injected agents
• respiratory problems
• abnormal development in speech

The cost of cleft lip and palate surgery in India

Cheiloplasty is commonly called cleft lip surgery. It is a general defect of birth coming into the picture of improper development during pregnancy. A cleft lip is not a critical defect, and many hospitals are available to correct the lip at reasonable prices. It only needs proper treatment in infant age to prevent feeding, dental or speech-related problems.

The treatment for the cleft palate and lip in an affordable amount is in India. The cost of the treatment can vary from 25000 to 300000 INR. The amount can differ from cities, Hospitals and the surgical method to correct the cleft palate or lip. In most hospitals in India, the treatment cost can be Rs 1,36,620-Rs 2,01,670 or $2200-$3000.

The cost includes

1. Tariff of the healthcare team and the surgeon
2. Cost of Anesthesia
3.  Medical Examinations
4. Prescriptions required
5. Providing meals or food after surgery

Best doctors for cleft lip and palate surgery in India

India has highly experienced doctors who can meticulously provide treatment for these little kids. They aim to bring forth the best treatment for each individual in helping them fulfil their needs. There is a list of the best doctors for cleft lip and palate surgery.

1. Dr. Anil Behl

Cosmetic Surgeon

MBBS,MS,M.Ch

Gurgoan, India

• Dr Anil Behl is the finest and most highly experienced plastic surgeon studying at the prestigious Armed Forces College in Pune. He is currently working at Fortis Memorial Research Institute.
•  He has a Rich experience of over 38 years and was awarded Ati Vishisht Seva Medal and honoured to perform surgery for the President of India.
•  Dr Behl has expertise in Craniofacial, Aesthetic, Reconstructive and Hand surgeries. He also works for post-Burns treatments.

2. Dr Amitabh Singh 

Consultant

MBBS,MS,M.Ch

Gurgoan, India

• Dr Amitabh Singh is a prominent and well-experienced plastic surgeon in India.
• He has an experience of over 12 years with an interest in post-weight loss plastic surgeries and has posted several journals with his updated skills.
• Dr Singh is in fellowship with Lowa City and Emory University in the USA for plastic surgery.

3. Dr. R.K Seth

Senoir Consultant

MBBS, MS,M.Ch

New Delhi, India

• Dr R.K Seth is a renowned cosmetic surgeon holding membership from India in Aesthetic, craniofacial and cleft lip plastic surgeries.
• Has a vast experience of over 33 years and has written a book chapter, along with various short courses and presentations for national and international ranks.
• Dr Seth is a member of the Council for Craniofacial surgery in the Asian Pacific Association.
• He holds a fellowship with the Indian Association for Aesthetic Plastic Surgery, Plastic surgeons of India Association, and the Indian Association for craniofacial and cleft lip surgery.

4. Dr. Prateek Arora

Associate Director

Cosmetic and Plastic surgery

MBBS,MS,M.Ch

New Delhi

• Dr Prateek Arora is a renowned and experienced plastic surgeon currently an Associate Director in the Max Superspeciality group of hospitals.
• He is in association with several medical groups linked in the Cosmetic, Plastic, Aesthetic and Reconstructive fields. And as an association with Max Superspeciality group from 2008.
•  Dr Prateek specializes in Cosmetic, Hand, and Microvascular surgeries. Rhinoplasty, Liposuction, Abdominoplasty, burn care, Reconstructive and Aesthetic face surgeries.

5. Dr. Avtar Singh Bath

Head and Senior Reconstructive and Plastic Surgery Consultant

Plastic Surgeon

MBBS,MS,M.Ch

New Delhi, India

• Dr Avtar Singh Bath (Maj.Gen.) is a celebrated and highly experienced doctor, former HOD and professor of Army hospital cantonment Delhi, currently working in BLK Super Speciality Hospital.
• He has a massive 29 years of experience glorifying his Portfolio and receiving numerous awards like Awards from the president, the Dr. of the year award and the President of the Plastic Surgeons Association of India.
•  Dr Bath is the first Indian to begin calvarial grafting of bone procedures and malformations in arteriovenous with innovative tendons treatments for injury on hand.
• He has expertise in Cosmetic, Plastic, Hand and Microvascular surgery.

6. Dr. Kaveshvar Ghura

Plastic Surgeon

MBBS,MS,M.Ch

Gurgoan, India

• Dr Kaveshvar Ghura is an excellent plastic surgeon with prior experience working in prominent hospitals in India like Apollo, Asian and Sunflag Hospitals.
• He has ten years of experience in the Plastic Surgery field, currently in association with Fortis Memorial Research Institute.
• Dr Ghura specializes in Microsurgery, Cosmetic and Hand surgeries and Burns and Onco-Reconstructions.

7. Dr. Surendra Kumar Chawla

Senoir Consultant

Plastic Surgeon

MBBS,MS,M.Ch

Gurgoan, India

• Dr Surendra Kumar Chawla is a prominent Cosmetic Surgeon at Fortis Group and has completed his M.Ch from the highly acclaimed Safdarjung hospital.
• He has experience of 10 years being in the plastic surgery field and a senior dr at Fortis Memorial Research Institute.

8. Dr. Manoj K Johar

Senoir Head and Director

Reconstructive and Plastic Surgeon

MBBS,MS,M.Ch

New Delhi, India

• Dr Manoj K Johar is a well-known Reconstructive and Plastic Surgeon, currently in association with Max Super Speciality Hospital.
• He is highly skilled with experience of above 30 years of and focuses on patients’ needs driving satisfaction from the response of the treated patient.
• Dr Johar’s expertise in Laser Aesthetic and Cosmetic Surgery from (Harvard) along with other treatments like Anti-ageing, Regenerative and Plasticity Medicine, Reconstructive, Micro and General Plastic Surgery.

9. Dr Lokesh Kumar

Plastic Surgeon

HOD & Director

MBBS,MS,M.Ch

New Delhi, India

• Dr Lokesh Kumar is a quantified and well-known Cosmetic and Plastic surgeon currently in alliance with BLK Super Speciality Hospital.
• He has 26 years of rich experience and is in fellowship with the International College Of Surgeons, Chicago, USA.
• Dr Kumar has expertise in Microvascular, Aesthetic, and Cosmetic Surgeries.

These are all the best plastic surgeons in India.

Best hospitals for cleft lip and palate surgery in India

It is better to get appropriate treatment and surgery for the cleft lip or palate before a year or two. Since there is a possibility of the child developing an inferiority complex in growing years that can hamper mentally. Pick the best hospital in India for cleft lip/palate that can take care of the child and correct the defect seamlessly to let the child lead a good life unaffected by a minor defect. There is a list of the best hospitals for cleft palate and lip surgery in India.

• Paras Hospital (located in Haryana and Gurgaon)
• Fortis Hiranandani hospital (located in Navi Mumbai)
• Jaslok Hospital (located in Mumbai)
• Metro heart institute (located in Haryana and Faridabad)
• Kokilaben Dhirubhai Ambani Hospital (located in Mumbai)
• Global Hospital (located in Mumbai)
• Dr LH Hiranandani hospital (located in Mumbai)
•  BLK Super Speciality Hospital (located in New Delhi)
• Metro hospital and multispecialty Institute (located in Noida)
• AMRI hospital (located in Kolkata)
• Manipal hospital (located in Kolkata)

More Info About Cleft Lip and Cleft Palate