Treatment
Treatment plan
General principles of surgical intervention
The treatment of a child with cleft should be undertaken by a TEAM of Specialists that is trained and experienced in the entire spectrum of the treatment of clefts. In experienced hands, the total stay of a child with cleft in the hospital, until the completion of treatment, is not more than a week to ten days, since each hospitalization for surgery is from one to three days, with few exceptions.
The timing of cleft surgical treatment varies from patient to patient. Our TEAM preference is presented:
1
Correction of cleft lip starts at the age of three months if it is full. During the operation two flaps are created from which one rotates and the other is promoted in the void which is created by the rotation. The scars that result follow the natural direction of the filter of the lip and more often they become nearly invisible over time.
In bilateral cleft the problem is much more complex. The principles of recovery are the same as in the cleft lip, but two or three stage surgeries are needed, depending on the cleft. In the first stage the lip is corrected, while in the next the columella of the nose which is almost always short will be elongated. Presurgical orthopedics (NAM) used by the TEAM orthodontist, helps a lot the columella to elongate before surgery.
2
3
Correction of cleft palate is usually done during the twelfth month of age and includes correction of the soft palate (ie the back part of the palate that moves and includes the muscles of the palate) and the hard palate up to the area of the alveolus (where teeth grow).
The restoration of the alveolar area is done later, usually at the age of 9-11 years old. The surgical closure of cleft palate plays a major role in the subsequent growth of the maxillary complex and speech development.
In cases where there is a cleft in the area of the alveolar crest, a prerequisite for the completion of the orthodontic treatment is to have a bone graft in the cleft region, i.e. the gap is filled with bone that is usually taken from the pelvis, so that the permanent cuspid can be erupted and an ideal dental arch is created for correct occlusion and a beautiful smile.
This operation is usually done when the child is around 9-11 years of age.
If there is a bilateral cleft, there is a possibility that the graft cannot be done from both sides simultaneously, and two sequential operations will be required.
4
Presurgical orthopedics
“Presurgical orthopedics” begins from the first week of the baby’s life.
The orthodontist prepares the special device, NAM type (Naso Avleolar Molding). The device is placed in the upper jaw of the baby and helps in the preparation of the surgery on lip and nose that will take place around the third month of the baby’s life.
More specifically, this treatment aims at settling the alveolar process and hence in the correction of the dental arch. In addition, it brings the lips together so the postoperative scar is minimized. Finally, it contributes substantially to the uplifting of the cartilage of the nose for better aesthetic results.
Άρθρα
Breastfeeding cleft babies
The psychology of children with clefts and their families
Getting your baby ready for surgery
The TEAM of scientists who contribute to the treatment of Clefts and other Facial Deformities, includes the following specialists:
Craniofacial Plastic Surgeon
Comes into contact with the patient’s family from the moment of birth, planning the surgeries to be carried out. The first surgeries, which are associated with the aesthetic and functional recovery of the patient, are the ones that will determine the full or incomplete recovery of the patient. Any unappropriated surgeries and failures– especially in the initial stages – lead to partial restoration, omitting the possibility of total treatment of the patient’s condition
Craniofacial Plastic Surgeons of the MEDICLEFT TEAM are Dr. George Psaras and Dr. Costas Alexandrou, Director of the Hellenic Craniofacial Center (HCC).
Orthodontist – Specialist in Clefts and Facial Deformities
Settles and moves the teeth where needed. Supports the efforts of the plastic surgeon and the oral and maxillofacial surgeon. Implements “presurgical orthopedics” (NAM) from the first week of the birth, in order to have a correct preparation of all anatomical structures for the first operation, which will be performed when the baby is three months of age.
Orthodontist – Specialist in Clefts and Facial Deformities of the MEDICLEFT TEAM is Dr. Christodoulos Laspos.
Speech-language Pathologist
Speech language therapy is essential during the preschool and school period of a child’s life. Speech therapy will treat the child to have the right utterance, to correct speech problems. In collaboration with the plastic surgeon, will decide on the possible need for pharyngoplasty.
Speech-language pathologists of the MEDICLEFT TEAM are Maria Kyriacou Solomonidou and Sofronia Stavrinides.
Oral and Maxillofacial Surgeon
Oral and Maxillofacial Surgeon collaborates with the orthodontist and the plastic surgeon for the necessary surgery on jaws, like bone graft and orthognathic surgery.
Oral and Maxillofacial Surgeon of the MEDICLEFT TEAM is Dr. Zoe Nicolaou. Dr Nicolaou has special interest and expertise in Orthognathic surgery.
Otolaryngologist (ENT)
Frequent infections of the upper respiratory tract and ear problems in particular, make the supervision by an ENT essential, in order to avoid subsequent problems. If necessary, he puts ventilation tubes during the surgery for lip closure.
Otolaryngologist the of MEDICLEFT TEAM is Dr. Fyras Khalil.
Pediatric Dentist
With frequent examinations ensures to preserve the child’s teeth in good condition. This will help later in the orthodontic and surgical treatment.
Pediatric Dentists of the MEDICLEFT TEAM are Dr. Mando Angelidou and Dr. Stella Ioannou.
Prosthodontist
Collaborates with the Oral and Maxillofacial Surgeon and the Orthodontist to restore teeth that may be missing.
Prosthodontist of the MEDICLEFT TEAM is Dr. Paraskevas Paraskeva.
Neurosurgeon
Essential to collaborate with the plastic surgeon in craniosynostosis surgeries and in Le Fort III surgeries on children with syndromes like Apert and Crouzon.
Neurosurgeon of the MEDICLEFT TEAM is Dr. Kanaris Panagopoulos.
Ophthalmic Surgeon
Cooperation with the plastic surgeon is essential , when facial deformities include abnormalities that involve the orbits.
Physical Therapist
Works closely with the plastic surgeon in treatments of children with plagiocephaly.
Physical Therapist of the MEDICLEFT TEAM is Melios Athanasiades with a great experience since he has been working with Dr Shaton for at least 10 years.
Geneticist
The geneticist has also a very important role in the TEAM. He informs about the possibility of having the next child with the same problem and he consults the patient himself, when he reaches the age to have his own family. He also makes a diagnosis if there is a syndrome.
Pediatrician
Checks the child from the first day of his/her life and is responsible for his/her proper nutrition and weight gain, so that the infant can cope with the procedures of the surgeries that will start from the third month of his/her life.
Psychologist
Supports the parents but also prepares the child and monitors his/her behavior especially during the first school year.