Complications
Inadequate nursing techniques or pediatric care of feeding difficulties may lead to poor weight gain and subsequent developmental delay. Neonatal consultation with a feeding nurse specialist and pediatrician is advised for children with cleft lip and palate or isolated cleft palate.
Closure of the nasal floor and anterior palate, which is undertaken at the time of alveolar bone grafting unless a gingivoperiosteoplasty is performed, is occasionally insufficient in the presence of a large alveolar cleft. This leads to the formation of an oronasal fistula.
Surgical wound infection of the lip or palate is extremely serious as it results in wound dehiscence, excessive scarring, and impaired muscular function. Factors contributing to the development of postsurgical wound infection include poor infant nutrition, excessive wound tension, and inadequate wound care.
Speech dysfunction related to an orofacial cleft is complex and should be analyzed with the input of a speech and language pathologist. If hypernasal speech is not responsive to therapy, speech surgery is warranted following a velopharyngeal dysfunction evaluation by the surgeon and speech pathologist.
Malposition of the teeth due to the cleft alveolus may also cause phoneme-specific articulation errors that require ongoing speech therapy.
Placement of pressure equalization tubes in the tympanic membranes carries a risk of perforation when the tubes extrude. This risk is increased with chronic otorrhea and otitis media.
Tympanoplasty is delayed until at least 7 years of age, by which time the craniofacial morphologies (e.g., skull base slope, adenoid regression) create improved Eustachian tube function.
Hearing aids are often warranted while awaiting surgery following consultation with an otolaryngologist and audiologist.
Palatal fistula occurs in approximately 10% to 20% of palatoplasties.[77] The rate of palatal fistula formation is related to the severity of the cleft, nutritional status of the infant, and technique of the surgeon, among other factors. Appropriate choice of flap design and tension-free palatal closure are suggested in order to reduce the risk of palatal fistula formation. Delaying a secondary procedure to close a fistula is warranted to allow maxillary and palatal growth. An obturator can be made by a dentist to occlude the defect for the benefit of speech and swallowing.
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