(return to index)
HEAD AND NECK
Paediatric Plastic Surgery, especially cleft lip and palate surgery, is one of the areas of special interest to Mr. João Nunes da Costa.
Cleft palate consists of a defect in the "roof of the mouth" that allows communication between the nasal cavity and the inside of the mouth, causing serious problems for the child, namely:
- Difficulty in feeding, including food escape through the nose and bottle suckling problems
- Severe changes in physical ability to speak, including inability to reproduce certain sounds, nasal voice or air escape through nose during speech, which lead to difficulty in expression and relationship with others
Cleft palate is a congenital disease that may also include a cleft of the lip (cleft lip and palate). In most cases, it is not associated with other pathologies, although there are several syndromes that can present it as one of its characteristics. The cleft may extend from the lip to the palate (labioalveolopalatine clefts), include most of the palate (complete secondary cleft palate) or affect only the posterior part, in the soft palate (including the uvula). However, even the smallest slits present the same problems in speech, since the muscles that give rise to the sound variations that result in the speech are all in the most posterior part of the palate.
The correction of this disease implies, therefore, both the closure of the communication between the mouth and nasal fossa, and the reorientation of the muscles responsible for speech. It is a surgery that is performed ideally between 9 and 12 months before the baby's speech begins, and when the anaesthetic risk is lower and the structures are already large enough to be mobilized in an effective and safe way.
But the treatment of the cleft palate does not end with surgery, a long period of follow-up and speech therapy is necessary to boost the results. Videofluoroscopy assessment may be indicated after 3-4 years in order to identify problems with the palate that imply a surgical revision (velopharyngeal insufficiency).
