Cleft Lip and Palate Surgery

During pregnancy the fetus develops rapidly, but unfortunately some malformations related to tissue can occur, most frequently in the face. To correct these facial and oral abnormalities, cleft lip and palate surgery is performed soon after birth, followed by a series of other interventions depending on the severity of the deformity. There is a relatively high number of babies born with cleft lip and palate in the U.S., about one baby out of 2,500 is born with this condition. Cleft lip and palate surgery is recorded to be the fourth most common birth defect surgical procedure.

• Cheiloschisis or cleft lip is explained as a physical separation of the two sides of the lip. It is like an opening in the skin, extending sometimes beyond the base of the nose, the bones of the upper gum and jaw.
• Palatoschisis or cleft palate is an opening in the hard and soft palates.
• Both conditions can occur in either side of the mouth.

Despite the medical research on cleft lip repair, the causes are basically unknown. What is even more disquieting is that the condition is not considered to be preventable. Nevertheless, many causes are believed to contribute to the development of cleft lip and palate. Some doctors argue that the condition is related to genetics, or medication and drugs taken during pregnancy such as Accutane and Methotrexate. Defective genes passed down from one or both parents; viruses, drugs or toxins may cause the birth defect, but the medical consensus is yet to be fully established. Cleft lip and palate frequently occur along with other birth defects and genetic syndromes.

Cleft lip and Palate Surgery: Diagnosis and Treatment

Prenatal ultrasound usually determines if the unborn shows signs of cleft lip and palate. After birth, however the condition is immediately visible at the first physical examination of the newborn.

A small notch in the lip or a complete split from the base of the nose is the most common and easily detectable symptom. In addition, a change in the shape of the nose or poorly aligned gums also indicate cleft lip and palate.

Some related problems that might call for an urgent cleft lip and palate surgery are in connection with feeding, failure to gain weight and poor growth. Because of the opening in the nasal passages nurturing becomes problematic. Furthermore, ear infections are also recurring problems and the development of speech takes much longer.

Among cheiloschisis and palatoschisis related health problems solution include:

• Eating problems – Children might need an artificial palate to help them eat properly until surgical treatment is provided.
• Ear infection and hearing loss – special tubes are placed in the eardrums to aid fluid drainage.
• Speech problems – speech therapy can help overcome this difficulty.
• Dental problems – usually repaired through surgery.

Due to the medical and oral health problems associated with cleft lip and cleft palate surgery, a group of interdisciplinary medical specialists are involved in the treatment, which is usually ongoing from childhood until adulthood.

The team includes:

• Plastic surgeons
• Otolaryngologists
• Oral surgeons
• Dentists
• Prosthodontist
• Speech pathologists
• Speech therapists
• Audiologists
• Nurse coordinator
• Social worker
• Psychologist
• Geneticist

The Procedure

• Cleft lip and palate repair is not necessary in all cases, because on some occasions the babies heal without a long series of surgical interventions.
• The treatment requires several surgeries over the course of 18 years, depending on the severity of the condition, beginning when the baby is 3 months old.
• This first cleft lip surgery creates a functional palate and aids the proper development of facial bones and teeth.
• Cleft palate surgery requires bone graft to fill up the upper gum to support permanent teeth. Further cleft palate surgery is needed to help speech and articulation.
• Some other surgeries are performed to improve lip and nose appearance, and to stabilize the jaw and breathing.