Cleft Lip and Cleft Palate

Description

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 1 in every 800 babies, these 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 defect in the roof of the mouth, or palate, is called a cleft palate. Since the lip and palate develop separately, it is possible for a child to have a cleft lip, a cleft palate, or variations of both.

If a child is born with either or both of these conditions, most often surgery is recommended to repair it.

Cleft Lip Surgery

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 usually 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. He or she will then turn the dark pink outer portion of the cleft down and pull the muscle and the skin of the lip together to close the separation. Muscle function and the normal "cupid's bow" shape of the mouth are restored. The nostril deformity often associated with cleft lip may also be improved at the time of lip repair or in a later surgery.

Cleft Palate Surgery

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 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.

After surgery, the child will feel some soreness and pain, which is easily controlled by medication. During this period, the child will not eat or drink as much as usual, so an intravenous line will be used to maintain fluid levels.

Children with 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 surgeon may recommend that a small plastic ventilation tube be inserted into the eardrum. This relatively minor operation may be done later or at the time of the cleft repair. In addition, surgery may be recommended when the child is older in order to refine the shape and function of the lip, nose, gums, and palate.

When surgery is done by a qualified plastic surgeon the results can be very positive. The most common problem is one of asymmetry. The goal is to close the separation and create a normal look. If this is not accomplished in the first operation, a second operation may be necessary.

Questions to Ask Your Doctor

Is the problem one of a cleft lip, cleft palate, or both?

How extensive is the abnormality?

How can it be repaired surgically?

When should the surgery be performed?

How successful is this type of surgery in correcting the problem?

Is there a risk of ear infections later?

How can this be prevented?