William Callaghan. MD (Cleft-Lip-and-Palate Surgery)
Cleft Lip and Palate
Cleft lip and palate occur when the lips and/or palate do not fuse together in the early part of pregnancy. This process can also involve the nose and gums
Sometimes it can only be a part of the palate (soft) or involve the entire palate only, and other times it can be as severe as two sides of the lip, palate, and the nose.
Cleft lips are more common in boys (with or without the palate) and cleft palate is more common in girls.
Cleft lip with or without cleft palate is generally more common among boys; however, cleft palate occurring alone is more common in girls than boys.
The causes of cleft lip/palate are many. Sometimes they are associated with syndromes (other parts of the body), sometimes they can run in families, sometimes environmental factors (certain medications, smoking), but most of the times they are unknown.
Cleft lip and palate are associated with other problems. These include difficulty feeding, speech, hearing loss (fluid build-up in middle ears), and dental abnormalities.
- 1. Feeding difficulty: This occurs because the infant is unable to create suction when trying feed by the nipple.
- 2. Hearing problems: This occurs because of fluid build-up in the middle ear. The fluid build-up occurs because there is a malfunction of the Eustachian tube (the tube connecting the middle ear and the throat). Infants usually require a tube through the eardrum to drain the ears. For this reason infants and children must have their hearing regularly checked.
- 3. Dental abnormalities: Children tend to have small teeth, missing teeth, malpositioned teeth, and even additional teeth. Also, there is often a problem with the gums. It is important that an orthodontist and dentist to be involved as part of the
- 4. Speech Problems: The speech problems generally are more often with those who have cleft palates. Patients may require surgery and speech therapy These patients tend to have “nasal” speech.
The cleft lip/palate patient are complex problem which require a team of specialists: oral surgeon, dentis, orthodontist, speech therapist, audiologist, otolaryngologist, psychologist, nurse, pediatrician, and a plastic surgeon. Each has his/her own duties at various times of the treatment process.
A cleft lip is usually repaired between the ages of 3 to 6 months. The children who have very wide clefts of the lip may require a procedure such as lip adhesion or a device (molding plate) to bring the parts closer together before the full lip repair. Surgery is performed in the hospital under general anesthesia.
A cleft palate is usually repaired between 9 and 12 months of age. By repairing the palate, the soft palate muscles from each side are connected to each other and the normal barrier between the mouth and nose created. The operation is performed under general anesthesia
Sculptra is another injectable that contains synthetic material.
The goal of surgery is to create a palate that works well for speech. Some will continue to sound nasal after cleft palate repair and some may become nasal due to natural growth changes or adenoid shrinkage.
In some cases, additional surgery may be needed to improve speech. This surgery is called a pharyngoplasty. It is often done when kids are in their early school years, but also can be done later.
Additional operations, such as an alveolar bone graft, which is used to close the gap in the bone or gums near the front teeth. This provides stability for the permanent teeth and is usually done when kids are between 6 and 10 years old.
Other procedures might be options as kids get older. They may want to have their scars made less noticeable, improve the appearance of their nose and upper lip, improvement with the appearance of the nose, or improve their bite with orthognathic surgery. These operations may improve speech and breathing, dental occlusion, and appearance.
Dental and Orthodontic Treatment
Maintaining healthy teeth are very important in these patients. Regular care (floss and brsushing) is an absolute.
Orthodontic treatment is common in kids with cleft lip and palate and may begin as early as 6 years of age. Often orthodontic treatment involves various phases, typically starting with palatal expansion done to normalize the width of the palate. Later, braces are put on to place the teeth in their proper position. Your orthodontist will discuss timing of the phases of treatment with you.
Patients who are missing teeth will either have an implant placed or an appliance.
A specialist will meet with parents early, when the child is approximately 7-9 months. The therapist reviews the treatment plan and how to monitor the speech development.
Emotional and Social Issues
Some kids struggle growing up with a cleft lip or cleft palate and might need help handling certain situations. The psychologists and social workers on the cleft palate team are available to help children and parents. Most children with cleft lip or cleft palate grow up to be healthy, happy adults.
Below are tips to help guide parents:
The focus should not be on the deformity, but rather the child. Just as with any other child.
A warm, supportive, and accepting home environment.
Encourage children to develop friendships with people from diverse backgrounds.
Emphasize positive attributes in others that do not involve physical appearance.
Encouraging your child to present information about cleft lip and palate to his/her class with a special presentation that you arrange with the teacher.
If your child is teased, talk about it and be a patient listener. Provide tools to confront the teasers by asking what your child would like to say and then practicing those statements. Keep the lines of communication open as your child approaches adolescence so that you can address his or her concerns about appearance.
If your child has difficulty with self-esteem or other psychosocial situations, contact a child psychologist or social worker for support and management.