Treating Clefts

The good news is that there have been much medical advancement in the treatment of oral Clefting. Reconstructive surgery can repair cleft lips and palates, and in severe cases, plastic surgery can address specific appearance-related concerns.

A child with oral Clefting will need to see a variety of specialists who will work together as a team to treat the condition. Treatment usually begins in the first few months of an infant's life, depending on the health of the infant and the extent of the cleft.

Members of a child's cleft lip and palate treatment team usually include:

• a geneticist
• a plastic surgeon
• an ear, nose, and throat physician (otolaryngologist)
• an oral surgeon
• an orthodontist
• a dentist
• a speech pathologist (often called a speech therapist)
• an audiologist
• a nurse coordinator
• a psychologist

The team specialists will evaluate your child's progress regularly, examining your child's hearing, speech, nutrition, teeth, and emotional state. They will share their recommendations with you, and can forward their evaluation to your child's school, and any speech therapists that your child may be working with.

In addition to treating your child's cleft, the specialists will work with your child on any issues related to feeding, social problems, speech, and how you approach the condition with your child. They'll provide feedback and recommendations to help you through the phases of your child's growth and treatment.

Surgery for Oral Clefting

Surgery is usually performed during the first 12 to 18 months to repair cleft lip and/or cleft palate. Both types of surgery are performed in the hospital under general anesthesia.

Cleft lip often requires only one reconstructive surgery, especially if the cleft is unilateral. The surgeon will make an incision on each side of the cleft from the lip to the nostril. The two sides of the lip are then sutured together. Bilateral cleft lips may be repaired in two surgeries, about a month apart, and usually requires a short hospital stay.

Cleft palate surgery involves drawing tissue from either side of the mouth to rebuild the palate. It requires 2 or 3 nights in the hospital, with the first night spent in the intensive care unit. The initial surgery is intended to create a functional palate, reduce the chances that fluid will develop in the middle ears, and help the child's teeth and facial bones develop properly. In addition, this functional palate will help your child's speech development and feeding abilities.

The necessity for more operations depends on the skill of the surgeon as well as the severity of the cleft, its shape, and the thickness of available tissue that can be used to create the palate. Some children with a cleft palate require more surgeries to help improve their speech. Additional surgeries may also improve the appearance of the lip and nose, close openings between the mouth and nose, help breathing, and stabilize and realign the jaw. Subsequent surgeries are usually scheduled at least 6 months apart to allow a child time to heal and to reduce the chances of serious scarring.

It's a good idea to meet regularly with your child's plastic surgeon to determine what's most appropriate in your child's case. Final repairs of the scars left by the initial surgery may not be performed until adolescence, when facial structure is more fully developed. Surgery is designed to aid in normalizing function and cosmetic appearance so that the child will have as few difficulties as possible.