Male: Once the diagnosis is made, the first approach is feeding. Is that correct?
Doctor: Correct feeding is the number one problem.
Male: Once you established that depending on the extent of the problem, the team approach, which we have discussed will decide at what stage is and what time certain things should be done. So if an ideal case came to have a cleft lip and a cleft palate, the logical approach would be when you would close the lip, when would you close the palate in an ideal case.
Doctor: In an ideal case, you are going to want to close the lip at about 10 weeks of age.
Male: Because surgical risks at a 10-week older is not so bad, is that so?
Doctor: That is a good question. Why 10 weeks and it is 10 weeks if you ask any surgeon. It is the rule of 10s which one answer is that at his 10 weeks of age, hemoglobin, blood values are at a certain level all around. The answer is that at about 10 weeks they are out of that very acute risk of a newborn like you said, anesthetic-wise. They are also a little healthier, they are stronger, they can eat a little better, so if for one they do not eat that fast, they were to eat that long after surgery. They have got some strength in reserve.
Male: If you close then, does that mean he may not get another surgeon and there might be a plastic procedure sometimes later down the road, is that true?
Doctor: In many case, you need secondary surgeries, w the kids are a little bit older to touch up their nose and lip.
Male: That is where cosmetics…
Doctor: Yes, more cosmetics. Right now, the techniques that we are using really are good and a lot of the babies I have been doing now, I would anticipate that there are only very, very little secondary surgery for cosmetic purposes as they grow older.
Male: In the palate to close, specifically would be at what age?
Doctor: Eight months of age is the best time to close the palate and that there is a couple of reasons why. Number one, you do not want to close it earlier because the baby usually does not going to eat for a day or two after cleft palate surgery so you would like them to have a little bit of reserve where they can withstand a day or two of just IV fluids. There has been a big emphasis to the late closure of the palate originally say, when 20 or 30 years ago, the thinking was to wait until the child is two years of age because when you close the palate you may have some effects on the way the baby grows. However, the tendency is to push it as young as possible. At eight months of age seems to be the ideal setting. The baby is doing a very liquid in diet, soft foods. They do not have the dexterity to take a lot of things in their mouth which could disrupt the surgery. They are in a very controllable stage and the blood loss seems to be very minimal with that stage. The palate is still not very wide and you can get an easy closure. If you wait longer, in theory, you may help the baby grow a little bit better, but you want that palate to be closed before the baby starts to talk.
Male: The feeding difficulties are minimized.
Doctor: The feeding difficulties in the baby, if you think about the baby at eight months of age is going to start to develop and right at that cause we start to seeing where the baby will learn. By a year of age, the baby is going to know to tell where his mama is or papa and you are going to be a little bit more animated and so you would like them to have an intact palate so they can speak well.
Male: Next logical times sequence will be for what?
Doctor: Well, the first two things of a cleft lip and a cleft palate and after that, you are in a surgical period. You do not need very much surgery.
Male: So who would be involved in the next period?
Doctor: The next period is speech, pediatric, EENT, your nose and hearing and orthodontist and children’s dentistry. Those things will be take over the role at the age of about two to about nine or ten.
Male: Because with the cleft, the teeth may not be in the right location, the secondary teeth may not be their. Just going to be a lot of other problems that you
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