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Cleft Palate


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.

If your 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. 

This 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.

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 – Stony Brook Medical Center and has been performing Cleft surgery since 1985. 

When 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.

At 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.

In 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. 

To 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 properly. 

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 cleft. 

Tissue is drawn together from both sides of the cleft to rebuild the roof of the mouth.

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.

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. 




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