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Congenital anomalies

Congenital anomalies

Nefertiti Clinic provides complex treatment of congenital cleft lip and palate, as well as other anomalies in any part of the body.

What is cleft lip and palate?

Cleft lip and palate are congenital anomalies which are formed during the first weeks of pregnancy, when the face of the infant is formed - the two parts of the lip/palate develop independently and grow approaching each other, finally joining in the middle. Due to a number of reasons, for children having that anomaly, the final process of joining of the two sides is not completed in the way it is for all others which results in the cleft. Congenital cleft lip alone or in combination with cleft palate is one of the most frequently occurring congenital misshapes in newborn. Cleft lip involves the upper lip, and cleft palate - the hard and the soft palate. The lack of tissues under one of the nostrils is called unilateral cleft lip. When tissues are missing under both nostrils we have bilateral cleft lip. Cleft gum may be concomitant to cleft lip, and there exist different degrees of that misshape as well - from small recess to complete segmentation of the gum into two individual parts. Cleft palate results when the tissues in the upper part of the oral cavity, forming the palate are not able to join completely during the period of organogenesis. The posterior part of the palate (to the throat) is called soft palate, and the anterior part (to the mouth) is called hard palate. The palate cleft may also vary from a small gap to almost complete segmentation of the hard and soft palate tissues. A child may be born with lip cleft only, with palate cleft only, or with both. The cases in which both kinds of cleft are witnessed amount to 30% of that type of defects, in 30% there is only cleft palate, and cleft lip alone - in the remaining 30%.

What causes cleft lip and palate and why do they appear?

The reasons for the appearance of congenital clefts are still unclarified. Evidence exists that genetic factors influence these malformations. If a close relative has got similar defect, the probability of a child being born with the same misshape is higher. The risk of repetetive appearance depends on many factors, such as number of affected people from the family tree of the child, their closenes within the family tree, the gender of the affected and the extent of the congenital anomaly. Such misshapes occur more frequently with the children of more elderly couples. Major part of the children born with cleft lip are boys, whereas clift palate prevails in girls.

It is practically established that the major part of such type of anomalies appear as a result of a combination of genetic anomalies and environmental factors. It is believed that the major risks are associated with:

* Environmental factors - harmful emissions in the air or toxins.
* Alcohol consumption, smoking of cigarettes, or drug abuse by the mother during the first weeks of pregnancy.
* Use of medicines by the mother during the first weeks of pregnancy.
* Insufficient quantity of folic acid in the organism of the mother.
* Excessive concentrations of Vitamin A in the organism of the mother.

The factors, causing the appearance of these misshapes are effective from the 3rd to the 12th week of pregnancy. After that critical period no cause could bring about the appearance of such malformation, and nothing could be done in order to avoid the appearance of the defect. In most cases that happens when the mother does not even suspect that she is pregnant.

What could be done when the defect is available?

Congenital cleft lip and palate are subject to successful corection. The latest world trends and our long practice in corrective plastic surgery indicate that best results are achieved if the operative intervention for closing the upper lip cleft is undertaken as early as possible - in the first days after birth. Subsequently the treatment continues with different corrections - from the first month till the age of 21.

Highly experienced and qualified specialists work at Nefertiti Clinic, which gives us the unique possibility for Bulgaria to perform operations of the newborn in the first few days after birth. Besides, our clinic is the only one in Bulgaria possessing the neccessary know-how, knowledge and expertise for performing the intervention at such an early age. The operation is performed under general anesthesia and lasts about an hour. Assoc. Prof. Dr. Emil Georgiev sets in order and joins available tissues and muscles, which does not necessitate transfer from other parts of the body. The infants recover exceptionally quickly and have almost no pains during the postoperative period. The hospitalization of the baby and the mother at the clinic is for 24 hours.

Measures have to be taken for the child to be able to eat more normally till its development makes it possible to perform surgical correction of the palate. The treatment consists of construction of special lamellas replacing the natural filling of the palate cleft and establishing prerequisites for successful subsequent intervention.

In the period between the sixth and twelveth month intervention for palate cleft correction is undertaken. The operation lasts about an hour to an hour and a half, and is again performed under general anasthesia. Assoc. Prof. Dr. Emil Georgiev sets in order and joins available tissues and muscles, which does not necessitate transfer from other parts of the body. The hospitalization lasts three days. The cosmetic intervention on the nose is usually undertaken before the child starts school or later in the teenager period.

The cleft lip is a serious cosmetic defect, but through precise surgery good solution could be found, whereas cleft palate is a defect with much graver consequences involving the speech and linguistic capabilities of the child. That necessitates the intervention of an experienced surgeon to close the cleft, but also additional therapy by orthodont and logopedist to control the teeth development and speech capabilities.


Children born with some of the malformations described above require much and specialized care on the part of their parents, as well as qualified surgical intervention, dental and ortodont care, logopedist assistance. Such care is to be rendered in coordination and at strictly differentiated time-intervals during the years.

Medicine still does not enable us to assert that we could make a child with such malformation look like any other normally born child, but we try to render the best complex treatment to the children, taking care about their good looks, correct development and complete social adaptation in socciety and amonth their coevals.

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