Cleft Lip and Palate Surgery
Cleft lip and cleft palate are birth defects. In other words, this occurs during the developmental process in the womb. Normally, the mouth and nose of a baby develop between the first 6 and 12 weeks of growth. In some babies, parts of the lips and roof of the mouth don't grow together. Because the lips and the palate develop separately, it's possible to have cleft lip, cleft palate, or both.
In most cases, we simply don't know why lip and palate development go wrong. Race and gender play a small role as clefts are most common in Asians. They are less common in whites and least common in blacks. Boys are more often affected than girls
Cleft Lip Surgery Patient 1: This child had a unilateral cleft lip deformity that was repaired and a one year follow up photo.
Problems associated with the cleft. Medical professionals with special experience in the problems of cleft lip and palate have formed such teams all over the country to help parents plan for their child's care from birth, or even before. Members of a child's cleft lip and palate treatment team usually include:
- an audiologist (who assesses hearing);
- a surgeon (such as a plastic surgeon, an oral / maxillofacial surgeon, a craniofacial surgeon, or a neurosurgeon);
- a pediatric dentist or other dental specialist (e.g., a prosthodontist, who makes prosthetic devices for the mouth);
- an orthodontist (who straightens the teeth and aligns the jaws);
- a geneticist (who screens patients for craniofacial syndromes and helps parents and adult patients understand the chances of having more children with these conditions);
- a nurse (who helps with feeding problems and provides ongoing supervision of the child's health);
- an otolaryngologist (an "ear nose and throat" doctor, or "ENT");
- a pediatrician (to monitor overall health and development);
- a psychologist, social worker, or other mental health specialist (to support the family and assess any adjustment problems);
- a speech-language pathologist (who assesses not only speech but also feeding problems);
Treatment usually begins in the first few months of an infant's life, depending on the health of the infant and the extent of the cleft.
Cleft Lip Surgery Patient 2: This child had a bilateral cleft lip deformity that was repaired and a one year follow up photo.
For Cleft lip surgery, the surgeon will make an incision on each side of the cleft from the lip to the nostril. The two sides of the lip are then sutured together. Bilateral cleft lips require a different surgery.
General agreement exists that surgical correction of a cleft palate should be accomplished when patients are younger than 1 year, before significant speech development occurs. The potential benefits of an intact palate as a child begins to speak are believed to outweigh the possible complications of early closure. Surgery for both cleft palate and a cleft lip require general anesthesia.
The goal of repair in patients with cleft palate is to separate the oral and nasal cavities; this separation involves the formation of a valve that is both watertight and airtight. The valve is necessary for normal speech. The repair also helps with preserving facial growth and the development of proper dentition. Cleft palate surgery involves drawing tissue from either side of the mouth to rebuild the palate. It requires 2 or 3 nights in the hospital, with the first night spent in the intensive care unit.
The necessity for more operations often depends on the severity of the cleft, its shape, and the thickness of available tissue that can be used to create the palate. Some children with a cleft palate require more surgeries to help improve their speech. Additional surgeries may also improve the appearance of the lip and nose, close openings between the mouth and nose, help breathing, and stabilize and realign the jaw. Subsequent surgeries are usually scheduled at least 6 months apart to allow a child time to heal and to reduce the chances of serious scarring.