A four month-old-baby has cleft lip and palate. How would you manage the baby ?
.LAHS classification of cleft disorders:  'L' for lip, 'A' for alveolus, 'H' for hard palate, 'S' for soft palate  Capital 'LAHS' for 'complete' type  Small letters 'lahs' for 'incomplete type'  Asterisks 'lahs' for microclefts  'LAHSHAL' for bilateral clefts Treatment for Cleft Lip: Millard criteria is used to undeake surgery for cleft lip Millard criteria (Rule of '10')  10 pound in weight  10 weeks old  10 gm % haemoglobin a. Millard cleft lip repair by rotating the local nasolabial flaps. b. Management of associated primary or secondary cleft palate deformity. c. Proper postoperative management like control of infection, training for sucking, swallowing and speech. d. Tenninson's 'Z' plasty (Tenninson-Randall triangular flap). Note: Delaire timing of the cleft surgery - Unilateral/ bilateral cleft lip alone, in one stage operation done in 4-6 months. For cleft palate alone involving only soft palate, in one stage surgery is done in 6 months. For cleft palate alone but involving both soft and hard palates - soft palate in 6 months; hard palate in 18 months. In combined cleft lip and palate, unilateral or bilateral, in two stages - cleft lip and soft palate in 6 months; hard palate in 18 months. Treatment for Cleft Palate: Criteria for surgery  *10 kg weight  *10 months of age (10-18 months)  *10 gm % haemoglobin  Cleft palate is usually repaired in 12-18 months. Early repair causes retarded maxillary growth (probably due to trauma to growth center and periosteum of the maxilla during surgery if done early). Late repair causes speech defect. Both soft and hard palates are repaired. Ref: SRB's Manual of Surgery, 4th Edition, pg. no. 368,372
Immediate repair of the lip
Immediate repair of the lip and palate
Delayed repair of the lip and palate until 2 years
Delayed repair of the lip and palate until preschool age
Trauma