This article is expertly advised by Associate Professor, Dr. Lam Hoai Phuong, Chairman of the Ho Chi Minh City Association of Plastic Surgery and Reconstructive Surgery. Ho Chi Minh City, Vice President of Vietnam Odonto-Stomatology Association, former Head of Department of Maxillofacial Surgery at UNIVERSITY MEDICAL CENTER HCMC, Professor at Ho Chi Minh City Medicine and Pharmacy University, Director of the American Odonto-Stomatology Hospital Thien.
Currently in Vietnam, the rate of children with cleft lips and palate is 1/500 children. If not treated promptly, it will affect the child's aesthetics, ability to speak, eat and the risk of causing some respiratory diseases. young. Cleft lip and palate are treated surgically, but surgery is not necessary immediately after birth. My Thien Hospital is one of the first places to have a treatment regimen specifically for each child with cleft birth defects from birth to 18 years old. The treatment process will be divided into 10 different stages corresponding to each age as follows:
Stage 1: Newborns to under 3 months old – Use the NAM - Taping appliance
At this stage, the child needs a comprehensive examination to diagnose cleft lip and palate and other defects (if any). Depending on the type and width of the cleft lip and palate, children will have varying degrees of difficulty breastfeeding. Mothers should note that breastfeeding a SMHHE baby will take more time and effort to achieve the same amount of milk compared to a normal baby. After a comprehensive diagnosis, the RHM doctor will let the child wear the N.A.M - Taping device.
This is an orthopedic device to treat newborns with cleft lip and palate that is designed by the doctor according to each child's condition. The infant will wear the appliance every day until just before lip surgery. Children need pre-operative orthopedic treatment by a RHM doctor in the following cases:
• Cleft lip and wide entire palate
• Premaxillary protrusion (with bilateral cleft palate)
• Nose wings and nasal pillars are flat and deformed
• The baby sucks little and chokes often
• The child's tongue is always inserted into the cleft
The doctor will make a specialized appliance for the child that fits tightly in the mouth and is fixed by a tight fit with the hard palate, vestibular recess and adhesive tape on both cheeks. This instrument has the following roles:
• The appliance prevents communication between the nasal cavity and the oral cavity, thus reducing choking. Helps babies suck more easily
• The appliance helps narrow the width of cleft lip, cleft jaw, and cleft palate by 20-35%, supporting future plastic surgery for a more beautiful shape.
• Advanced reshaping, rounding the nose wings, straightening the nasal pillars.
• Push the premaxilla medially (with bilateral cleft palate)
• Prevents the tongue from entering the gap and does not make the gap wider
• Length the shortened lip, creating the most favorable conditions for surgery
The process of fitting the appliance begins when the child is 2 days old if the child is healthy, making it easier to care for and nurture the child, creating good conditions for future surgery. Treatment with the NAM appliance may require weekly follow-up visits to correct gum and lip movement. By the end of the treatment period, the child's nose will have a more natural shape.
Stage 2: From 3 - 6 months old - Lip and soft palate repair surgery
From 3 to 6 months old is the ideal time to perform lip and soft palate surgery on children. The child will be anesthetized for surgery so must ensure good health conditions and must weigh 6kg or more.
Depending on the degree of deformity, surgical methods will be different. However, the general goal is to recreate the shape of the red lips and nose and try not to leave bad scars for the child. When the child becomes an adult, he or she can have surgery again to fade the scars and correct them. lips (if necessary).
Stage 3: 9 months and older – Dome patch surgery
If your baby has a cleft palate, the doctor will prescribe surgery to repair the cleft palate. Cleft palate surgery is more complicated, so it will be treated when the child is 9 - 12 months old, weighs 10kg or more and is in good health. For palate surgery, early surgery helps children eat and pronounce better. Therefore, arch surgery is very important before the age when children begin to learn to speak. Similar to lip surgery, depending on the condition of each child, arch surgery may be performed as late as 18 - 24 months of age or may need to be performed multiple times to achieve the best results.
Time in hospital:
• Lip surgery: 1 day
• Palate surgery: hospital stay is about 1 - 3 days
Stage 4: At 3 years old – Assess hearing function
Usually children with cleft lip and palate will have otitis media, affecting the child's hearing (ability to hear). Therefore, along with the correct surgery regimen, children also need the help of speech experts to help evaluate hearing function for timely detection and treatment.
It can be said that 3 years old is the GOLDEN TIME to intervene on listening and speaking functions for children. Children must listen and understand correctly to be able to develop standard pronunciation. This will be a sure stepping stone for children to develop language and easily integrate into school.
Stage 5: From 4 to 6 years old - Pronunciation treatment
Parents who have regular contact with their children will find it difficult to recognize that their children have pronunciation problems such as lisping or unclear pronunciation. This is extremely influential when children go to school, limiting their ability to communicate with friends and absorbing knowledge slowly. Therefore, at this stage, children need to have their pronunciation assessed to improve their voice clarity and aim for further functional improvement.
For children who have labiaplasty surgery after age 3, pronunciation treatment is even more necessary. Exercise helps children adapt to the cleft before surgery. At the same time, after surgery, children also need to learn new ways to pronounce words again.
Stage 6: From 5 to 7 years old – Reconstruction of velopharyngeal insufficiency/reconstruction of nasal wings
One of the causes of unclear pronunciation and lisping in children is velopharyngeal insufficiency. To improve and limit this mispronunciation, at this stage the doctor will create a pharyngeal flap. At the same time, the children will have surgery to reconstruct their nose wings and round them.
Stage 7: From 9 to 11 years old – Bone graft surgery
Previously, surgery was limited to reshaping the gap using soft tissue tissue, while bone defects at the gap site were not given much attention. Therefore, after surgery, children are still at risk of deforming the maxillary bone defect, the alveolar bone defect greatly affects teeth growth as well as affecting aesthetics. At My Thien Hospital, leading doctors have come up with a treatment regimen to help completely solve the problem through grafting the upper jaw and alveolar bones to bring a perfect appearance to the child.
Stage 8: From 14 to 16 years old – Orthodontics
In children with cleft lip and jaw, the permanent teeth when they grow are often misaligned and crowded together, especially the incisors and canines. Straightening the teeth on the dental arch will be carried out at 14 to 16 years old. Orthodontic work not only brings aesthetic beauty, but it also plays a very important role in eating, chewing, and helping the correct development of the child's jawbone and permanent teeth.
Stage 9 & 10: From 14 to 18 years old – Cosmetic surgery
To further improve the aesthetic aspect, the next stage to maximally overcome the disadvantages from the sequelae of cleft lip and palate, the doctor may prescribe scar removal and shaping the entire nose and lips with cosmetic surgery. beauty, helping children become normal people. Families need to have their children follow up with regular check-ups according to the doctor's schedule to determine the appropriate type of surgery.
With the desire to bring maximum perfection to children, My Thien Hospital is a TRUSTED place to treat cleft lip and palate. At My Thien Hospital, the staff hopes that parents will always have enough necessary and useful knowledge to best care for their babies.
Please connect with My Thien to receive timely advice and treatment from doctors at the right stage and age to minimize the consequences caused by deformities. For more enqueries, please contact us by phone at (028) 6650 5188 or via Hotline 0915 22 66 03.
