Repair Cleft Palate & Lip Metairie LA
Some of the most common North American birth defects that occur in 1 or 2 of every 1000 babies born each year are cleft lip and cleft palate. In fact; singular, isolated clefts or those that occur without any other major birth defects are one of the most common types of birth defect in the United States.
These types of orofacial clefts are birth defects wherein there is either an opening in the child’s lip and/or roof of the mouth (palate).
These defects are usually caused by incomplete development during the earlier formative stages of the fetus.
Development of Cleft Lip and Palate
During the beginning stages of pregnancy, the baby’s head begins to form, as well as tissues and cells joining together to make a face. These tissues, when joined, begin to form a baby’s distinct facial features, like the lips and mouth.
Causes of Cleft Lip and Palate
The three main types of clefts can be categorized as 1) a cleft lip without a cleft palate, 2) a cleft palate without a cleft lip, and 3) a cleft lip and a cleft palate together.
It is during these earlier stages of pregnancy that the cleft (or separation) usually begins to occur in the unborn child’s face, due to certain parts of the lip and/or roof of the mouth failing to form correctly. A cleft lip can be found on either side of the lip or, in rare cases, up the middle. In other cases, the opening can extend to the nose. Those born with a cleft lip may also have a cleft palate, once again caused by those cells and tissues in the roof of the mouth not being able to completely join together.
Some of the factors that may increase your unborn child’s risk of cleft lip or palate are if the mother smokes during pregnancy, has diabetes, uses certain types of medication during the earlier stages of the pregnancy, or a basic vitamin deficiency. Other causes may be through changes in genes, such as a history of cleft in the family, or through environmental factors, the mother may come in contact with during those same early stages.
A cleft condition may be recognized through prenatal ultrasounds, however, full diagnosis can be much more difficult, let alone seen.
The Effects of a Cleft Condition
A child born with a cleft condition may have trouble feeding, especially those newborns with a cleft palate. A cleft may also cause dental problems, hearing loss (including fluid buildup in the ear), and speech impairment.
There is Hope
Through advanced cosmetic plastic surgery techniques, those suffering from cleft lip and/or palate can have normality and basic mouth functions restored. Surgery to repair a cleft lip can usually take place in the first few months of life and is also strongly recommended within the first 12 months. Cleft palate repair is recommended within the first 18 months of life. In both cases, the earlier the surgery can take place, will usually be the better. These surgeries could also include further dental/orthodontic work and/or speech therapy.
Not only will surgery improve a child’s facial appearance, it may also help with breathing, hearing, and speech and language development. A surgeon or specialist will best advise when the surgery should take place and what follow-up may be needed.
Depending on the severity of the child’s condition, there are many that are standing by to assure the best possible outcome. Those that will be involved, working together to meet each of the needs of a child with a cleft lip or palate, are pediatricians, craniofacial surgeons, plastic surgeons, ear, nose and throat specialists, oral surgeons, orthodontists, and dentists. Further help and learning can come from speech and language pathologists, audiologists, and psychologists.
Most children with a cleft defect will be able to live a normal, healthy life, when treated appropriately and timely.
Frequently Ask Questions
What is cleft lip and cleft palate?
Both cleft lip and cleft palate are birth defects that usually occur very early in pregnancy, a crucial stage in the development of the child’s lips and mouth. These conditions are known as “orofacial clefts,” and result when there is not enough tissue in the mouth or lip area, preventing the sides from joining. Cleft lip, with or without cleft palate, affects one in 700 U.S. babies annually.
A cleft lip is a physical split or separation of the two sides of the upper lip and appears as a narrow opening or gap in the skin of the upper lip. A cleft lip may happen on either side of the lips or on both sides. Very rarely, this occurs in the middle part of the lip.
A cleft palate is a split or opening in the roof of the mouth, also known as the palate. A cleft palate can involve the bony front portion of the roof of the mouth (the hard palate) or the soft palate that is the back portion of the roof of the mouth.
Because the lips and the palate develop separately, it’s possible to have a cleft lip and palate together or separately.
What is cleft lip and palate surgery?
Children with a cleft lip or cleft palate will grow up facing difficulties in certain aspects of daily living, including the basics of eating and speaking. Due to fluid accumulation, these children are also more susceptible to ear infections and hearing problems. Surgery is the recommended remedy.
A cleft lip may require one or two surgeries, depending on the extent of the situation. The first surgery should be performed by the time the child is three months old.
For a cleft palate, multiple surgeries are usually required over the child’s first 18 years, the first surgery coming somewhere between six and 12 months. That first surgery creates a functional palate to allow for the proper development of the teeth and corresponding facial bones. It also lessons the chances of fluids pooling in the middle ears. Some children with cleft palate may need a bone graft around age eight to support the incoming permanent teeth. Additional surgeries will be likely to improve the appearances of the lip and nose, to stabilize the jaw, aid breathing, and resolve other issues.
What is cleft lip and palate surgery timeline?
Before the procedure
Before undergoing cleft lip or cleft palate repair surgery, the child has to maintain a healthy state to keep the body strong for surgery. Before any surgery is considered, you can expect your child’s surgeon to conduct a complete physical assessment, go through their entire medical history, and run a blood test. As a parent, it is important that you inform your child’s surgeon or nurse of whatever drugs or vitamins you are giving your child.
Ten days prior to the day of the surgery, you likely will need to stop administering certain medications to your child: aspirin, warfarin, ibuprofen, and other drugs that can interfere with the body’s blood-clotting ability.
Several hours before surgery, the child will need to fast, taking only sips of water to accompany any pre-surgery medication prescribed by the surgeon. If the child is ill, surgery will probably need to be rescheduled.
After the procedure
Once the surgery is completed, you can expect your child to spend five to seven days recovering in the hospital. It will take weeks to heal completely from the procedure. Post-operative care needs to be meticulous. The surgery site must be kept clean and should not be stretched or put under pressure for about three to four weeks. The wound may either be cleaned with soap and water or with a special cleaning ointment and kept moist using medications prescribed by the doctor.
During his or her recovery, your child may need to be put on a liquid diet and wear arm cuffs to prevent picking of the surgical wound. You’ll need to monitor play, keeping an eye out especially for the child putting anything in his or her mouth.
What is cleft palate recovery like?
After your child’s surgery, he or he will be taken to the recovery room for at least four hours. When your child is ready, he or she may be transferred directly to the plastic surgery unit. On the first night, your child will be placed in a croupette, a plastic tent that is installed inside the crib. This will help mist the air that your child breathes to promote comfortable and easy breathing.
Pain medication will be prescribed and given as needed. Your child will be receiving special liquids through an intravenous line to facilitate proper nutrition. For the first two days post-surgery only liquids will be ingested, things like water, milk, pudding, and yogurt. This is to allow the surgical wounds to heal, as well as to limit the chances of infection. While your child may resist due to the discomfort in the mouth, feeding with liquids as often as you can is important. You’ll receive instructions on the best ways to handle these issues.
Three days after cleft palate surgery, your child may be ready for solid foods such as mashed potatoes or spaghetti. Avoid large pieces of food. And do not allow your child to feed alone, as he or she can accidentally damage the surgical wounds. You may notice food or liquids coming out of your child’s nose when feeding; this is a normal occurrence for several weeks after cleft palate surgery.
When positioning your child at bedtime, make sure to raise the head of the bed slightly to prevent swelling in the mouth. Post-surgery, your child may have to wear arm restraints to keep his or her hands from the surgical site and from putting things into the mouth. Make sure to have your child drink water after eating or drinking to help keep the sutures clean. In case of soreness in the area, you may apply Vaseline to the corners of his or her mouth. Your surgeon will provide you with more information on how you can properly take care of your child at home after surgery.
What is a unilateral cleft lip?
A unilateral cleft lip affects only one side of the area. The cleft could range from fairly minor, which could appear as a small nick in the child’s lip, or extensive, involving not only the lip but also the alveolus (dental ridge) and palate. A unilateral cleft lip could be at any level between these two conditions.
Most unilateral cleft lip conditions can affect the child’s nose. Since the cleft lip has separated muscles, they pull away from each other in an asymmetrical fashion against the nostril closest to the side of the cleft. This causes the nostril to become larger and more horizontal. Furthermore, this pull can cause the central column of the nose’s cartilage to shorten, dividing the nostrils and making the nose appear much lower than usual.
In the case of a unilateral cleft lip and alveolus, the open groove can prevent the dental ridge from growing teeth properly. While teeth may come down, they will most likely be positioned in a crowded or abnormal manner. Often, this type of unilateral cleft lip can also affect the nose, causing asymmetry on the cleft side.
What is a bilateral cleft lip and palate?
A bilateral cleft lip is a type of cleft lip that affects both sides of the lips. This condition can range from minor to extensive, just as with unilateral cleft lips. Since there are two clefts in the child’s lip, the area appears to be divided into three segments. The middle segment usually is without muscles or a colored border. This type of cleft lip could either be symmetrical or asymmetrical, which occurs when a part of the lip is segmented more on one side than on the other. Children who are born with bilateral cleft lip usually experience nasal malformation due to their condition. However, it may not affect the nose, especially when it is a symmetrical cleft that only involves the upper lip’s outer portion.
The least common form of bilateral cleft lip is one that involves the palate. In this instance, the lip, as well as the alveolus (dental ridge) and the palate are divided into three portions. While the lip is usually completely divided into two sides, the alveolus may not be completely divided, with only one particular side bearing an obvious indention or groove. When the alveolus is completely divided into three segments, the middle bony part usually grows out of the limits of the child’s dental ridge. In a bilateral cleft lip and palate, it can either protrude forward or downward.
Usually, the dental ridge may lack teeth or grow them in an abnormal or rotated fashion. It is also possible for teeth to crowd each other in the palate. A bilateral cleft lip and palate create problems during feeding, as food and drink may be able to pass through into the nose easily because of the open area brought by the cleft palate. Parents are advised to take extra precautions when feeding their children who have the condition.