What is a cleft lip – cleft palate problem?

As the baby grows before birth (at 8-12 weeks gestation), parts of the face or palate may not grow together resulting in a space with missing tissue, a cleft. These clefts in the lip or palate may be partial or complete and may be missing bone, muscle, skin and fat tissue. All types of clefts are usually corrected surgically at an early age. These are the issues addressed at our Western Carolina Cleft Lip & Palate Clinic held once a month. To learn more about the clinic and your concerns contact our office at 864-641-1491.

What concerns need to be addressed for children with a cleft palate?

When there is a cleft palate and a missing portion of the roof of the mouth, initial feeding may be difficult because the baby cannot suck properly. Special feeding clinics provide nipple options and coaching to assist with good nutrition.

Pre-surgical tapes, splints or appliances will often be used to bring the various structures of the face into optimal position before surgeons repair the cleft palate. Dentists and orthodontists at our clinic may be of great help early on, and then later with dental care.

Cleft lip surgical repair takes place around three months and cleft palate repair is done at one year of age. This may improve the appearance dramatically but function is just as important. By having the roof of the mouth (the palate) repaired normal speech is possible.

Hyper-nasal speech occurs with sounds coming out the nose if the palate is missing or not moving correctly. If the palate is repaired by 12 months before the speech mechanism is required by the child, everything is easier. Wrong speech patterns do not develop and are avoided by this early cleft palate repair. Speech therapy is an on-going and integral part of treatment for a successful outcome.

An ear, nose and throat specialist (ENT) working with the cleft lip and cleft palate clinic may advise myringotomy tubes for the ears to prevent hearing loss and minimize ear infections. Children with cleft palates tend to have an increased incidence of middle ear problems. ENT assessments are routinely advised and available to optimize ear function.

Pediatricians and genetic counseling are arranged for all cleft children. This aids in determining if there are other issues, such as cardiac or kidney anomalies that occur with some clefts. The majority of children born with a cleft lip and cleft palate have no mental deficiencies.

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How frequently do cleft lip and cleft palates occur?

Cleft lip and cleft palate problems occur anywhere from 1 in 500 to 1 in 1,000 children born. Statistics indicate Asian children have higher cleft rates than Caucasians who, in turn, have higher cleft rates that those of African origins. Some genetically inherited conditions, such as Stickler’s syndrome, may have higher than usual inheritance rates for cleft lip and cleft palate issues.

What are the causes of a cleft palate or cleft lip?

Most clefts are caused by a combination of environmental and genetic components. Drugs such as accutane, radiation, and infections (particularly some viral infections) may cause clefting. Alcohol and tobacco products are associated with increased clefting. For most couples with a single cleft child there is a greater than 90 percent probability the next child will not have a cleft problem.

What other cleft palate surgery or cleft lip care do cleft children require?

As cleft lip children grow into school age they may require some form of open rhinoplasty. Frequently, the cartilage at the tip of the nose needs repositioning and the nostrils made more symmetrical.

If the lip is thin or deficient on one side, fat grafting from the abdomen may help create a full symmetrical lip. Fat is removed from the abdomen using an incision less than one-quarter inch and then injected into the lip via a one-eighth inch incision in the crease at the corner of the mouth. This may give a much fuller natural lip.

If there has been a cleft palate, orthodontic appliances are used to give correct dental alignment. Then, around 8-11 years of age, bone grafting may be required to provide a good foundation for the permanent teeth.

Speech therapy assessments are continued on a regular basis. Some children need speech therapy while others with a well-functioning palate need none. Because scar tissue (which is present in all repairs) does not stretch and grow equally, compared to normal tissue, there may be small touch-up surgeries required as the child grows.

These short-day procedures are very helpful before the child enters adolescence.

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