In the early
weeks of development, long before a child is born, the right and left
sides of the lip and the roof of the mouth normally grow together. Occasionally, however, in about
one of every 800 babies, those sections don't quite meet. A child born with a separation in
the upper lip is said to have a cleft lip. A similar birth defect in the roof
of the mouth, or palate, is called a cleft palate. Since the lip and the palate
develop separately, it is possible for a child to have a cleft lip, a
cleft palate, or variations of both.
child was born with either or both of these conditions, your doctor will
probably recommend surgery to repair it. Medical professionals have made
great advances in treating children with clefts and can do a lot to help
your child lead a normal, healthy, happy life.
information will give you a basic understanding of the operation -- when
it can help, how it's performed, and what results you can expect. It can't answer all of your questions,
since a lot depends on you individual circumstances. Please be sure to ask your surgeon
if there is anything you don't understand about the procedure.
THE IMPORTANCE OF A
Children born with a cleft lip or palate may need the skills of
several medical professionals to correct the problems associated with the
cleft. In addition to needing
plastic surgery to repair the opening, these children may have problems
with their feeding and their teeth, their hearing, their speech, and their
psychological development as they grow up.
For that reason, parents should seek the help of a Cleft
Lip and Palate Team as early as possible. 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.
Typically, a Cleft Team might include a plastic surgeon, a
pediatrician, a dentist, a speech and language specialist, a social
worker, a hearing specialist, an ear-nose-throat specialist, a
psychologist, a nurse, and a genetic counselor.
Dr. Duboys is
the founder and emeritus co director of the Cleft and Craniofacial team
at the State University of New York –
and has been performing Cleft surgery since 1985.
SURGERY CARRIES SOME UNCERTAINTY AND RISKS
surgery is done by a qualified plastic surgeon with experience in
repairing cleft lip or palate, the results can be quite positive. Nevertheless, as with any
operation, there are risks associated with surgery and specific
complications associated with this procedure.
In cleft lip surgery, the most common problem is
asymmetry, when one side of the mouth and nose does not match the other
side. The goal of cleft lip
surgery is to close the separation in the first operation. Occasionally, a second operation
may be needed.
In cleft palate surgery, the goal is to close the opening
in the roof of the mouth so the child can eat and learn to speak
properly. Occasionally, poor
healing in the palate or poor speech may require a second operation.
FOR YOUR SURGERY
your initial consultation, your doctor will discuss the details of the
procedure he or she will use, including where the surgery will be
performed, the type of anesthesia to be used, possible risks and
complications, recovery, costs, and the results you can expect. Your surgeon will also answer any
questions you may have about feeding your baby, by breast or by bottle,
both before and after the surgery.
In most cases, health insurance policies will cover most or all of
the cost of cleft lip or cleft palate surgery. Check your policy to make sure
your child is covered and to see if there are any limitations on what
types of treatment are covered.
some children, a cleft palate may involve only a tiny portion at the back
of the roof of the mouth; for others, it can mean a complete separation
that extends from front to back.
Just as in cleft lip, cleft palate may appear on one or both sides
of the upper mouth. However,
repairing a cleft palate involves more extensive surgery and is usually
done when the child is nine to 18 months old, so the baby is bigger and
better able to tolerate surgery.
repair a cleft palate, the surgeon will make an incision on both sides of
the separation, moving tissue from each side of the cleft to the center
or midline of the roof of the mouth.
This rebuilds the palate, joining muscle together and providing
enough length in the palate so the child can eat and learn to speak
When the roof of the mouth doesn't
grow together properly, the condition is called a cleft palate.
To repair it, the surgeon will make an incision along both sides of the
Tissue is drawn
together from both sides of the cleft to rebuild the roof of the mouth.
FROM CLEFT PALATE SURGERY
For a day or two, your child will probably feel some soreness and pain, which
is easily controlled by medication.
During this period, you child will not eat or drink as much as
usual -- so an intravenous line will be used to maintain fluid levels. Elbow restraints may be used to
prevent your baby from rubbing the repaired area. Your doctor will advise you on how
to feed your child during the first few weeks after surgery. It's crucial that you follow your
doctor's advice on feeding to allow the palate to heal properly.
REPAIRED LIP OR PALATE
Children with a cleft palate are particularly prone to ear infections
because the cleft can interfere with the function of the middle ear. To permit proper drainage and air
circulation, the ear-nose-and-throat surgeon on the Cleft Palate Team may
recommend that a small plastic ventilation tube be inserted in the
eardrum. This relatively
minor operation may be done later or at the time of the cleft
repair. In addition, surgery
may be recommended by your plastic surgeon when your child is older to
refine the shape and function of the lip, nose, gums, and palate.
Perhaps most important, keep in mind that surgery to
repair a cleft lip or palate is only the beginning of the process. Family support is critical for
your child. Love and
understanding will help him or her grow up with a sense of self-esteem
that extends beyond the physical defect.