Cleft lip and cleft palate are openings or splits in the upper lip, the roof of the mouth (palate) or both. Cleft lip and cleft palate result when facial structures that are developing in an unborn baby don’t close completely.
Cleft lip and cleft palate are among the most common birth defects. They most commonly occur as isolated birth defects but are also associated with many inherited genetic conditions or syndromes.
Having a baby born with a cleft can be upsetting, but cleft lip and cleft palate can be corrected. In most babies, a series of surgeries can restore normal function and achieve a more normal appearance with minimal scarring.
Symptoms and Complications
- A split in the lip and roof of the mouth (palate) that affects one or both sides of the face
- A split in the lip that appears as only a small notch in the lip or extends from the lip through the upper gum and palate into the bottom of the nose
- A split in the roof of the mouth that doesn't affect the appearance of the face
What Are the Complications Associated with Cleft Lip and Cleft Palate?
Beyond the cosmetic abnormality, there are other possible complications that may be associated with cleft lip and cleft palate, including the following:
- Feeding difficulties
- Ear infections are often
- Muscle function may be decreased
- As a result of the abnormalities, teeth may not erupt normally, and orthodontic treatment is usually required.
During your child's cleft surgery consultation, be prepared to discuss:
A cleft lip can be :
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- On one side of the lip (a unilateral cleft lip). This type is more common.
- On both sides of the lip (a bilateral cleft lip)
Several techniques can improve the outcomes of cleft lip and palate repairs when used appropriately before surgery. They are non-invasive and dramatically change the shape of the baby’s lip, nose and mouth:
- A lip-taping regimen can narrow the gap in the child’s cleft lip.
- A nasal elevator is used to help form the correct shape of the baby’s nose.
- A nasal-alveolar molding (NAM) device may be used to help mold the lip tissues into a more favorable position in preparation for the lip repair.
Your child’s surgeon will perform cleft palate repair using general anesthesia. The surgery takes between two to six hours, depending on the extent of surgery.
The goal of cleft palate repair is to close the separation in the palate and rebuild the roof of the mouth. The surgeon will make incisions on either side of the cleft to create flaps of muscle and tissue. The surgeon will reposition the muscles and tissues, then draw the flaps together and stitch them to close the cleft.
Is it safe?
Potential complications of a cleft palate repair include:
- Anesthesia reaction, such as an allergic reaction and problems with breathing
- Bleeding, which can lead to shock
- Damage to nerves, blood vessels, and muscles
- Poor wound healing
- Pulling together or puckering of tissue at the incision, called contracture
- Regurgitation of food and liquids into the nose, which is usually temporary
Is it painful ?
Some pain is normal after cleft lip and palate repair. Your surgeon and medical team will work together to achieve the best pain control possible, but your child may still experience discomfort. For pain, your child may be prescribed a painkiller medicine
A visible scar will be left after cleft lip repair surgery and it may appear red, swollen and bruised after surgery, but this will fade considerably as it heals, and your child gets older. Swelling may take a few weeks to settle, and the scar may get thick, lumpy, and even start to pull the lip back up as it shrinks in the first few months. This is all part of how a scar heals– be aware that it can take years for the scar to ‘settle’ into its final appearance.
It is important to keep the scar clean and free from scabs, as this helps with the removal of stitches. You will be shown how to keep your baby’s lip clean before you go home from the hospital.
Generally, you are advised not to use a dummy/comforter for several weeks after surgery, and to try and stop your child from putting their fingers or toys into their mouth.
Infections are rare but look out for warning signs including a raised temperature and loss of appetite.
Dietary restrictions are common after palate repair with liquid or puree diets recommended for several days. Some surgeons also recommend avoiding bottles, pacifiers, straws or other utensils as well for several days. Commonly, arm restraints are used after surgery to help prevent your child from touching or injuring the surgical site as it heals. Some surgeons allow these restraints to be removed temporarily, so long as your child is supervised and prevented from touching the surgical site or sucking their fingers.
The outcome of cleft lip and/or cleft palate repair will improve your child’s quality of life, including the ability to breathe, eat and speak. Secondary procedures on the lip or palate may, however, be needed for functional reasons or to reﬁne appearance. Even though the scars of a cleft lip repair are generally located within the normal contours of the face, they will always be present.
Things to keep in mind
Surgery to repair a cleft lip usually occurs in the first few months of life and is recommended within the first 12 months of life. Surgery to repair a cleft palate is recommended within the first 18 months of life or earlier if possible. Many children will need additional surgical procedures as they get older. Surgical repair can improve the look and appearance of a child’s face and might also improve breathing, hearing, and speech and language development. Children born with orofacial clefts might need other types of treatments and services, such as special dental or orthodontic care or speech therapy and orthognatic surgery from 18 years old