Treatment of Congenital Anomalies (Cleft Lip and Palate, First and Second Branchial Arch Syndromes) 

Treatment of Congenital Anomalies of the Maxillofacial Region

Cleft Lip and Palate, First and Second Branchial Arch Syndromes

Cleft lip and palate are the most common congenital facial malformations. They occur as a result of impaired formation of facial structures during intrauterine development and require planned surgical treatment, which begins in the first months of life and often continues until facial skeleton growth is complete.

First and second branchial arch syndromes are rarer congenital anomalies in which structures derived from the branchial apparatus are underdeveloped: the lower jaw, auricle, and soft tissues of the cheek and neck. Both conditions require specialized reconstructive treatment in Moscow and other major cities, in clinics experienced in managing congenital facial anomalies.

Cleft Lip and Palate

Cleft lip, or cheiloschisis, and cleft palate, or palatoschisis, may occur separately or in combination. The severity varies from minor non-fusion to a complete bilateral cleft involving the lip, alveolar process, hard palate, and soft palate.

Without treatment, the anomaly affects feeding in the newborn, speech development, bite formation, and development of the nasal structures.

Stages of Surgical Treatment

Surgical treatment of a cleft is a staged process, with each step timed to a specific age of the patient:

Cheiloplasty, or primary closure of the cleft lip, usually at the age of 3–6 months

Uranoplasty, or closure of the cleft palate, usually at the age of 9–18 months, before active speech formation begins

Bone grafting of the alveolar process during the mixed dentition period, usually at the age of 8–10 years

Corrective operations on the nose and lip during adolescence or adulthood, after completion of facial skeleton growth

Orthognathic surgery in cases of associated bite disorders

The specific plan and timing are determined individually by the surgeon depending on the type of cleft and the patient’s development.

Primary Cheiloplasty

The goal of the operation is anatomically correct suturing of the lip muscles and skin with formation of the proper contour. Techniques are used that allow the red border of the lip, philtrum, and nasal base to be restored as accurately as possible.

The operation is performed under general anesthesia. Duration ranges from 1.5 to 3 hours depending on the type and side of the cleft.

Uranoplasty

Closure of the cleft palate restores the anatomical separating barrier between the oral and nasal cavities, which is necessary for normal speech development.

Different techniques may be used, and the choice depends on the width of the cleft and anatomical features. After surgery, speech therapy is often required.

Corrective Operations in Adults

Patients who underwent treatment in childhood often seek additional corrective surgery in adulthood: correction of the nasal shape, correction of scar deformity of the lip, and improvement of the red border contour.

Such procedures are planned after completion of facial skeleton growth and are performed as independent stages.

First and Second Branchial Arch Syndromes

First branchial arch syndrome, including Treacher Collins syndrome, hemifacial microsomia, and other variants, is characterized by underdevelopment of the lower jaw, cheekbones, auricle, and soft tissues of one half of the face.

Second branchial arch syndrome mainly affects the soft tissues and includes lateral neck cysts and fistulas, as well as auricular anomalies.

Treatment of these conditions is staged and long-term. It may include distraction osteogenesis, or gradual bone lengthening using a distractor, auricular reconstruction, soft tissue plastic surgery, and later orthognathic procedures and prosthetic rehabilitation.

Treatment planning requires joint work between the surgeon, orthodontist, and, if necessary, audiologist.

Preoperative Preparation

Before surgery, CT imaging of the facial skeleton and orthopantomography are performed. If necessary, MRI of the soft tissues may also be required.

In complex cases, 3D modeling is used to plan the scope and staging of reconstruction. For patients with cleft palate, speech assessment by a speech therapist is mandatory before and after surgery.

Rehabilitation

Hospitalization after cleft surgery varies: after cheiloplasty, it usually lasts 5–7 days; after uranoplasty, 7–10 days. After corrective procedures in adults, hospitalization usually lasts 3–5 days.

Swelling in the surgical area may persist for 2–4 weeks. The final result forms over 6–12 months.

After uranoplasty, a special diet and restriction of speech load are prescribed. Speech therapy usually begins 1–3 months after surgery.

Contraindications

Contraindications include acute infectious diseases, severe systemic diseases in the stage of decompensation, and uncorrectable blood clotting disorders.

The appropriate age for each stage is determined individually by the surgeon.

Frequently Asked Questions

Can Cleft Lip Be Operated On in an Adult If It Was Not Corrected in Childhood?

Yes. Adult patients can undergo cheiloplasty with simultaneous nasal correction.

The result in adults differs somewhat from early treatment because it is no longer possible to influence the growth of structures. However, significant improvement in appearance and function is achievable.

Is a Speech Therapist Needed After Palate Surgery?

As a rule, yes. Surgery creates the anatomical conditions for normal speech, but speech skills require additional correction with a speech therapist, especially if treatment began later than the optimal timing.

How Many Operations Are Needed for a Complete Cleft Lip and Palate?

A full treatment course for bilateral cleft lip and palate includes several stages over 15–18 years, from cheiloplasty in infancy to orthognathic surgery in adolescence.

The exact plan is created during the initial consultation.

What Is First Branchial Arch Syndrome and How Is It Treated?

This is a congenital developmental anomaly in which the structures formed from the first branchial arch are underdeveloped: the lower jaw, cheekbones, and auricle.

Treatment is staged and may include distraction osteogenesis, auricular reconstruction, soft tissue plastic surgery, and orthognathic procedures.

It is best to begin treatment in childhood, but adult patients may also seek treatment.

Does a Scar Remain After Cheiloplasty?

A scar remains, but with proper technique it is placed along natural facial lines and becomes less noticeable over time.

The quality of the scar depends on the surgical method, the surgeon’s qualifications, and individual healing characteristics.

Book a Consultation

Book a consultation. The surgeon will review your situation, create a treatment plan, and explain each stage.