Cleft Lip & Palate

MANAGING A CLEFT LIP

When a child is developing, the face grows from the left and right sides and then fuses in the midline before birth. The roof of the mouth and lips are involved, and a non-fusion of either side results in a cleft. A cleft lip occurs when the upper lip remains separate.

A child needs a completely formed lip because it is vital for a healthy facial appearance, sucking, and sounds production during a speech. A cleft lip leaves an opening in the upper lip between the nose and the mouth. It resembles a fissure in the lip, and it could be a simple notch or a total separation of the upper lip that extends deep into the nose. A cleft is unilateral if it occurs on one side and bilateral if it involves both sides.

In certain instances, there may be the involvement of the gum, and it may be a little notch in the gum or a complete division of the gum into two separate parts. Cleft palate is a similar effect that takes place in the roof of the mouth.

A Cleft Palate

The Palate is the roof above the mouth, and it is comprised of bone, muscle, and a thin layer of epithelium present in the oral cavity. It is easy to feel your Palate by pressing your tongue against the top of your mouth. Its purpose is to separate the nasal cavity from the mouth, and it ensures air goes to the lungs and food in the mouth during chewing. It prevents food and liquids from going into the nose.

Just like a cleft lip, a cleft Palate occurs during the early stage of pregnancy due to the non-joining of the separate parts of the face during development. An opening in the roof of the mouth is known as a cleft palate. The Palate has two parts, the backside known as the soft Palate and the frontal part known as the Hard Palate. A cleft palate may involve the soft Palate alone or extend throughout the entire roof of the mouth, involving both the hard and Soft Palate.

In some instances, as seen in Pierre Robin sequence, the baby with a cleft palate presents with a small chin and difficulty breathing.

It is important to note that the Palate and lips develop separately, hence it is uncommon for a baby to be born with a cleft lip, palate, or both. The incidence of cleft defects is about 1 in every 800 babies.

Children born with either or both of these conditions usually require highly skilled professionals to manage problems and prevent complications that may arise during feeding, speech, hearing, and psychological development. Most cases require surgery for correction, and our experienced maxillofacial surgeons here at Gaston will give you an excellent result.

Treatment of Cleft Lip

The surgery for repair of a cleft lip is usually done when the child is around ten years. The surgical procedure aims to close the separated lips, preserve muscle function, and get a beautiful cosmetic appearance of the mouth and face. The deformity of the nose may be improved during the procedure, or a subsequent surgery may take place to correct nose deformities.

Treatment of Cleft Palate

Cleft palate surgery can be done when the child is between 7 and 18 months old. This process is dependent on the individual child and the surrounding conditions, especially in case the child has other associated health issues that may delay the surgery.

The significant aims of cleft palate surgery include:

• Closure of the gap or hole between the roof of the mouth and the nose
• Reconnecting the muscles that make the palate work
• Making the repaired Palate long enough so that it can perform its function properly

Several techniques may be employed by the surgeon to achieve these aims, and the choice and method will be discussed between the parent and the surgeon before the surgery.

The hard-cleft palate is often repaired between the ages of 8 and 12 years when the cuspid teeth begin to appear. The technique entails placing of hip bone into the bony cleft and closure of the communication from the nose to the gum tissue over all the three layers. It may be done in teenagers or adults as a single surgery or in conjunction with corrective jaw surgery.

What to expect in the post-operative period?

A successful repair of the defect makes it easy for the child to swallow food and liquids. However, in rare occurrences, a portion of the Palate may still split after surgery leaving a tiny hole between the nose and the mouth, causing occasional leakage of fluid from the mouth into the nose. This hole, known as fistula, if large enough, may cause eating problems and speech problems and may require further surgery to repair.