Cleft Lip & Palate
Cleft Lip
During early pregnancy separate areas of a child’s face develop individually and then join together, including the left and right sides of the roof of the mouth and lips. If the sections don’t meet, a cleft results. When the separation occurs in the upper lip, the child will have a cleft lip.
A cleft lip is an opening in the upper lip between the mouth and nose. It looks as though there is a split in the lip. It can range from a slight notch in the colored portion of the lip to complete separation in one or both sides of the lip extending up and into the nose. A cleft on one side is called a unilateral cleft. If a cleft occurs on both sides, it is called a bilateral cleft. A completely formed lip impacts more than a child’s facial appearance. It is also important for sucking and forming certain sounds.
A cleft in the gum may occur in association with a cleft lip. This may range from a small notch in the gum to a complete division of the gum into separate parts. A similar defect in the roof of the mouth is called a cleft palate.
Cleft Palate
The roof of your mouth is called a palate. It is made of bone and muscle and is covered by a thin, wet skin that forms the covering inside the mouth. You can feel your own palate by running your tongue over the top of your mouth. Its purpose is to separate your nasal cavity from your mouth.
The palate plays an extremely important role during speech. When you talk, it prevents air from blowing out of your nose instead of your mouth. The palate is also crucial when eating; it prevents food and liquids from going up into the nose.
Like a cleft lip, a cleft palate occurs in early pregnancy when separate areas of the face do not join together properly. A cleft palate is an opening in the roof of the mouth. The back of the palate is known as the soft palate and the front is called the hard palate. A cleft palate can range from an opening at the back of the soft palate to a nearly complete separation of the soft and hard palate.
Sometimes a baby with a cleft palate may have a small chin. A few babies with this combination may have difficulties breathing easily. This condition may be called Pierre Robin sequence.
Since the lip and palate develop separately, it is possible for a child to be born with a cleft lip, cleft palate, or both. Cleft defects occur in about 1 out of every 800 babies.
Children born with one or both conditions usually need the skills of several professionals to manage difficulties with feeding, speech, hearing, and psychological development stemming from the defect. In most cases, surgery is recommended. When surgery is performed by an experienced and qualified oral and maxillofacial surgeon like Dr. Griffitts, the results can be quite positive.
Cleft Lip Treatment
Cleft lip surgery is usually performed when the child is about ten years old. The goal of surgery is to close the separation, restore muscle function, and provide a normal shape to the mouth. The nostril deformity may be improved as a result of the procedure, or may require a subsequent surgery.
Cleft Palate Treatment
A cleft palate is initially treated with surgery when the child is between seven to 18 months old. This depends on the individual child and his/her situation. For example, if the child has other associated health problems, it is likely that surgery will be delayed.
The major goals of cleft palate surgery are to:
- Close the gap or hole between the roof of the mouth and the nose
- Reconnect the muscles that make the palate work
- Make the repaired palate long enough to perform its function properly
There are many different techniques that surgeons use to accomplish these goals. The choice of techniques may vary between surgeons and should be discussed between the parents and surgeon prior to surgery.
The cleft hard palate is generally repaired between the ages of 8 and 12, when the cuspid teeth begin to develop. The procedure involves placement of bone from the hip into the bony defect, and closure of the communication from the nose to the gum tissue in three layers. This surgery may also be performed in teenagers and adults as an individual procedure, or combined with corrective jaw surgery.
What can be expected after the surgery?
After the palate has been repaired, children will have an easier time swallowing food and liquids. However, sometimes a portion of the repair can split, creating a new hole between the nose and mouth.
If small, the hole may occasionally allow minor leakage of fluids into the nose. If the hole is large, it can cause significant eating problems and affect how the child speaks. This hole is called a fistula, and may need further surgery to correct.
