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. In about one of every 1000 babies, those sections do not quite meet. A child born with a separation in the upper lip is said to have a cleft lip. A similar birth anomaly 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. With the advances in prenatal ultrasound, it is easier to identify fetuses with clefts in the lip prior to delivery.
A cleft lip can range in severity from a slight notch in the red part of the upper lip to a complete separation of the lip extending into the nose. Clefts can occur on one or both sides of the upper lip. Surgery is generally done when the child is about 10 weeks old.
To repair a cleft lip, the surgeon will make an incision on either side of the cleft from the mouth into the nostril. Most importantly, the muscle will be freed and then stitched together with the skin closed over top of the muscle. The nostril deformity often associated with cleft lip may also be improved at the time of lip repair or in a later surgery. The scar will be red and raised at first, but it will continue to fade with time.
|TREATMENT & MANAGEMENT
If a cleft is identified prenatally, the parents are usually referred to a certified cleft team for a prenatal appointment. At this visit the parents usually meet with the plastic surgeon as well as other members of the cleft team. Medical professionals with special experience in the problems of cleft lip and palate have formed these teams all over the country to help parents plan for their child's care from birth, or even before. The Cleft Team typically includes plastic surgeons, pediatric dentists, orthodontists, otolaryngologists, oral and maxillofacial surgeons, speech and language specialists, behavioral psychologists, hearing specialists, a nurse, and a genetic counselor.
The surgery will take place typically as an outpatient. It usually takes a few hours to perform. After surgery, your child may need acetaminophen for discomfort. Some surgeons require that elbow restraints be used to protect the repair for a few weeks while other surgeons do not require these restraints. If dressings have been used, they will be removed within a day or two, and the stitches will either dissolve or be removed within five days. Your surgeon will advise you on how to feed your child during the first few weeks after surgery. It is normal for the surgical scar to appear to get bigger and redder for a few weeks after surgery. This will gradually fade, although the scar will never totally disappear. In many children, however, it's barely noticeable because of the shadows formed by the nose and upper lip.
|CLEFT PALATE SYMPTOMS
In some children, a cleft palate may involve only a small portion of the roof of the mouth or; 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 seven to twelve months old, so the baby is bigger and better able to tolerate surgery. Prior to surgery it is important that the baby is no longer drinking from a nipple or using a pacifier. These can interfere with the palate repair if used in after surgery. Typically, the child will transition to a sippy cup without a valve which is safe to use after surgery.
|TREATMENT & MANAGEMENT
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.
Unlike cleft lip repair, cleft palate repair requires an overnight stay at the hospital to be sure that the child has no problems with breathing. For a few days, your child will probably feel some soreness and pain, which is controlled by acetaminophen. During this period, your child may not eat or drink as much as usual. Once your child is drinking well you will be discharged home. Some surgeons require that elbow restraints be used to protect the repair for a few weeks while other surgeons do not require these restraints. Your doctor will advise you on how to feed your child during the first few weeks after surgery. It's crucial that you follow the 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 may be done at the same time of the cleft repair.
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 difference.