If
You're Considering Surgery to Correct
Cleft Lip or Palate...
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
one of every 800 babies, those sections don't 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 the
palate develop separately, it is possible for a child to have
a cleft lip, a cleft palate, or variations of both.
If your child was born with either or
both of these conditions, your doctor will probably recommend
surgery to repair it. Medical professionals have made great
advances in treating children with clefts and can do a lot to
help your child lead a normal, healthy, happy life.
This information will give you a
basic understanding of the operation - when it can help, how
it's performed, and what results you can expect. It can't
answer all of your questions, since a lot depends on you
individual circumstances. Please be sure to ask your surgeon
if there is anything you don't understand about the procedure.
The Importance of a Team Approach
Children born with a cleft lip or
palate may need the skills of several medical professionals to
correct the problems associated with the cleft. In addition to
needing plastic surgery to repair the opening, these children
may have problems with their feeding and their teeth, their
hearing, their speech, and their psychological development as
they grow up.
For that reason, parents should seek
the help of a Cleft Lip and Palate Team as early as possible.
Medical professionals with special experience in the problems
of cleft lip and palate have formed such teams all over the
country to help parents plan for their child's care from
birth, or even before. Typically, a Cleft Team might include a
plastic surgeon, a pediatrician, a dentist, a speech and
language specialist, a social worker, a hearing specialist, an
ear-nose-throat specialist, a psychologist, a nurse, and a
genetic counselor.
Ask your doctor for a referral to a
Cleft Team in your area. Or, for more information, contact The
Cleft Palate Foundation, 104 S. Estes Drive Suite 204, Chapel
Hill, NC, 27514, (telephone: 800-24CLEFT).
All Surgery Carries Some
Uncertainty and Risk
When surgery is done by a qualified
plastic surgeon with experience in repairing cleft lip or
palate, the results can be quite positive. Nevertheless, as
with any operation, there are risks associated with surgery
and specific complications associated with this procedure.
 |
| A
cleft lip is a separation of the upper lip that can
extend into the nose. |
In cleft lip surgery, the most common
problem is asymmetry, when one side of the mouth and nose does
not match the other side. The goal of cleft lip surgery is to
close the separation in the first operation. Occasionally, a
second operation may be needed.
In cleft palate surgery, the goal is
to close the opening in the roof of the mouth so the child can
eat and learn to speak properly. Occasionally, poor healing in
the palate or poor speech may require a second operation.
Planning for Surgery
At your initial consultation, your
doctor will discuss the details of the procedure he or she
will use, including where the surgery will be performed, the
type of anesthesia to be used, possible risks and
complications, recovery, costs, and the results you can
expect. Your surgeon will also answer any questions you may
have about feeding your baby, by breast or by bottle, both
before and after the surgery.
In most cases, health insurance
policies will cover most or all of the cost of cleft lip or
cleft palate surgery. Check your policy to make sure your
child is covered and to see if there are any limitations on
what types of treatment are covered.
Cleft Lip Surgery
 |
| To
repair a cleft lip, the surgeon will first make an
incision on each side of the cleft from the lip to the
nostril. |
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
generally 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.
 |
| The
cleft lip is then drawn together and stitched to
create a normal "cupid's bow" shape to the
upper lip. |
Recovering From Cleft Lip Surgery
Your child may be restless for awhile
after surgery, but your doctor can prescribe medication to
relieve any discomfort. Elbow restraints may be necessary for
a few weeks to prevent your baby from rubbing the stitched
area.
If dressings have been used, they'll
be removed within a day or two, and the stitches will either
dissolve or be removed within five days. Your doctor will
advise you on how to feed your child during the first few
weeks after surgery.
It's normal for the surgical scar to
appear to get bigger and redder for a few weeks after surgery.
This will gradually fade, although the scar will never totally
disappear. In many children, however, it's barely noticeable
because of the shadows formed by the nose and upper lip.
 |
| The
scar left after surgery will gradually fade with time. |
Cleft Palate Surgery
 |
| When
the roof of the mouth doesn't grow together properly,
the condition is called a cleft palate. To repair it,
the surgeon will make an incision along both sides of
the cleft. |
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 bigger and 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.
Recovering From Cleft Palate
Surgery
 |
| Tissue
is drawn together from both sides of the cleft to
rebuild the roof of the mouth. |
For a day or two, your child will
probably feel some soreness and pain, which is easily
controlled by medication. During this period, you child will
not eat or drink as much as usual - so an intravenous line
will be used to maintain fluid levels. Elbow restraints may be
used to prevent your baby from rubbing the repaired area. Your
doctor will advise you on how to feed your child during the
first few weeks after surgery. It's crucial that you follow
your doctor's advice on feeding to allow the palate to heal
properly.
The Repaired Lip or Palate
Children with a 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 ear-nose-and-throat
surgeon on the Cleft Palate Team may recommend that a small
plastic ventilation tube be inserted in the eardrum. This
relatively minor operation may be done later or at the time of
the cleft repair. In addition, surgery may be recommended by
your plastic surgeon when your child is older to refine the
shape and function of the lip, nose, gums, and palate.
You'll want to discuss further needs
with the members of the Cleft Team seeing your child.
Perhaps most important, keep in mind
that surgery to repair a cleft lip or palate is only the
beginning of the process. Family support is critical for your
child. Love and understanding will help him or her grow up
with a sense of self-esteem that extends beyond the physical
defect.
