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Patients with cleft lip and/or cleft palate: the role of the otolaryngologist

To commemorate World Cleft Lip and Palate Day -July 23-, we publish thisinterview with Dr.José Manuel Meléndez, ENT specialist at the Centro Integral Otorhinolaryngology (CIO). José Manuel Meléndez, otolaryngologist at the Centro Integral de Otorrinolaringología (CIO), specialist in rhinology and pediatric ENT, who works in the Rhinology, Allergy and Anterior Skull Base Unit, as well as in the Pediatric Otolaryngology Unit, on the occasion of the visit to the CIO of the president of the Association of Cleft Lip and Palate of the Balearic Islands (AFIBAL), Rosana García.

what are cleft lip and palate?Cleft lip and palate are openings or clefts in the upper lip or palate. Cleft lip and palate is one of the most common congenital malformations and occurs when the tissues that will give rise to the upper lip and palate do not completely unite before birth. There are different degrees of severity and a child can be born with cleft lip, cleft palate or both. Cleft lip and palate have an incidence of about 1:700-1000 births.What problems does a child with cleft lip and palate have?These children often have difficulty feeding, breathing properly and speaking clearly. Ear infections are very common and hearing loss may occur. It often results in delayed language development and problems with their teeth. Social development and self-esteem problems are also possible.How are cleft lip and cleft palate treated?Both cleft lip and cleft palate can be corrected with surgery. Surgical repair aims to improve the appearance of the face and make progress with the child’s feeding, breathing, hearing, and speech and language development. The first surgery for cleft lip is usually performed in the first few months of life, usually between the third and fourth month. The first cleft palate surgery is usually done before the baby is 18 months of age, usually between nine and twelve months. Many children will need additional surgical procedures as they grow older.How are cleft lip and palate patients managed?The management of these patients must be multidisciplinary, with a coordinated approach to the care of children. A large number of specialized services are necessary, including neonatology, pediatrics, maxillofacial surgery, pediatric surgery, otolaryngology, speech therapy, dentistry, orthodontics, physiotherapy, psychiatry, psychology and genetic counseling.What is the role of the otolaryngologist in these patients? The otolaryngologist will collaborate with these children in the adequate preservation of their hearing, which is fundamental in the rehabilitation process of their speech development. In addition, he/she will ensure that the breathing of the child with this condition is preserved in the best possible way, ensuring a functional nasal cavity. The surgical interventions most frequently performed by the otolaryngologist are: myringocentesis with placement of ventilation tubes, rhinoplasty, septoplasty, turbinoplasty and/or functional endoscopic surgery of the paranasal sinuses. Children in whom normal speech is not achieved may require pharyngoplasty, which will allow good control of the passage of fluids and air.Is there support for the families of these children?Support groups are very useful for families. AFIBAL is the Association of Physiopathology of the Balearic Islands that supports patients and their families in our autonomous community. It is a non-profit association chaired by Rosana García Mateo in an altruistic way.