Cleft Lip & Cleft Palate Repair

Watch Dr. Ciminello explain all you need to know about Cleft Lip & Palate

This deformity develops during early pregnancy, when separate areas of the face and mouth do not properly join together. In this video, Dr. Ciminello explains everything you need to know about this deformity and the available treatments

What causes Cleft Lip & Palate (Etiology)

The human face develops in separate pieces during pregnancy. A baby’s “whole face” is really made up of distinct pieces that then come together during the pregnancy.

When the parts of a baby’s face do not come together correctly, facial clefts are created. For example, if the parts of the face that make the upper lip fail to fuse, the result is a cleft lip. The same concept applies to cleft palates.

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Cleft Lip

A cleft lip exists when there is an opening in the upper lip between the mouth and nose. Clefts vary from small separations on the lip to large separations that go up into the nose. A cleft on one side is called a unilateral cleft, and a cleft on both sides is called a bilateral cleft.

 

Treatment & Timing of Surgery

 

For both the child’s safety and the best possible outcome, cleft lip surgery is performed when the child is about 3 months old.

 

The objective of cleft lip surgery is to close the separated lip tissue and restore oral competency, while simultaneously creating a normal shape and appearance for the mouth and nose. The ultimate goal is to restore function and eliminate the social stigma associated with this condition. When done well, it will be hard for others to even tell that a cleft lip ever existed.

 

Preoperative Management

 

  1. Education is Essential. Take the time to learn what is going on with your child and what the entire process is going to look like.

  2. A trained craniofacial surgeon should be your primary resource and guide to ensure that your child receives the care they need.  That being said, a cleft lip is a condition that requires experts from multiple disciplines to ensure the best possible outcome.

  • Pediatrician-Your pediatrician will make sure that your child is healthy and ready for surgery, and they will help assist in post-operative care.

 

  • Lactation specialist-A lactation specialist will help assist in breast feeding as well as the selection of bottle nipples (Haberman, Pigeon nipple, etc).

 

Day of Surgery

 

  • Take a deep breath.

  • Your child should not eat or drink 6 hours prior to surgery. You may give water or Pedialyte 4 hours before surgery, but nothing after that point. This will minimize any risks associated with anesthesia.

  • Arrive at the hospital 2 hours before your scheduled surgery time.

  • Typically, the operation takes 3 to 5 hours.

  • Afterwards, your child will have a small dressing on their lip.

  • In our practice, we recommend one overnight stay. Staying in the hospital for one night reduces parents’ stress; they should not have to worry about managing any acute, post-operative issues. Staying overnight allows the child to be fed by a trained professional, and it also puts a trained staff on hand to handle any post-operative pain management or any other potential issues that could arise.

  • Bring the child in weekly to see the surgeon for the next 2 to 4 weeks. After that, the child will just need monthly check-ins.

Post Surgery Photos of Cleft Lip Patients

About Cleft Palate

The palate is the roof of your mouth, separating your mouth from the nose. It is made of bone and muscle, and it is covered by a thin, wet skin that forms the red covering inside the mouth.

 

The palate is important for 2 essential activities: speaking and eating. Part of the palate moves back and prevents air from moving through the nose for certain sounds while speaking. If the palate does not function correctly, certain words and sounds can sound very nasal. (Doctors call this velopharyngeal insufficiency or hypernasality). The palate also prevents food and liquids from going up and out of the nose.

Treatment and Timing of Surgery

Cleft palate surgery is usually performed when a child is between 8 and 18 months of age. This is when early speech usually starts happening. So, the procedure is done around this time to ensure that your child is physically prepared to start talking.

 

Primarily, surgery is done to close the gap or hole between the roof of the mouth and the nose and reorient the muscles in the soft portion of the palate. The surgeon also makes the palate long enough so it can perform its function properly. Techniques vary between surgeons and the individual case of cleft palate.

Preoperative Management

 

  1. Education—This all starts with a discussion with a trained surgeon. They will help you understand your child’s condition, expectations, and next steps.

  2. It takes a highly-skilled, craniofacial team to handle your child’s cleft palate surgery and recovery.
     

  • Pediatrician-To optimize and ensure pre and post-operative health.

  • Lactation Specialist- To ensure proper nutrition and growth.

  • Otolaryngologist-To monitor and treat any hearing dysfunction.

  • Oral Surgeon/Dentist-To monitor dental development and jaw growth.

  • Speech Pathologist- To maximize post-operative speech development.

  • Board Certified Craniofacial Surgeon-To flawlessly complete the surgery.

Day of Surgery

 

  • ​Take a deep breath.

  • Your child should not eat or drink 6 hours prior to surgery. You may give water or Pedialyte 4 hours before surgery, but nothing after that point. This will minimize any risks associated with anesthesia.

  • Arrive at the hospital 2 hours before your scheduled surgery time.

  • The operation typically takes between 2 to 3 hours. 5.  After the surgery, your child will be brought to the recovery room where they will begin a liquid diet.

  • In our practice, we recommend one overnight stay. Staying in the hospital for one night reduces parents’ stress; they should not have to worry about managing any acute, post-operative issues. Staying overnight allows the child to be fed by a trained professional, and it also puts a trained staff on hand to handle any post-operative pain management or any other potential issues that could arise.

  • The child stays on a liquid diet for 1 week followed by a soft diet for 1 additional week. After these 2 weeks, an age appropriate diet is resumed.

  • Bring the child in weekly to see the surgeon for the next 2 to 4 weeks. After that, the child will just need monthly check-ins.

View of Cleft Palate Patients

References:

  1. Cleft Lip and Palate: Review Ciminello FS, Morin RJ, Nguyen TJ, and Wolfe SA Compr Ther. 35(1) pgs 37-43, 2009

  2. Pierre Robin Sequence: History and Pathophysiology Frank S. Ciminello MD, George Dreser MD, Nicole A. Anderson MD, and S. Anthony Wolfe MD, FACS Stryker Hyperguide, 2008

  3. Pierre Robin Sequence: Medical and Surgical Management Frank S. Ciminello MD, Nicole A. Anderson MD, George Dreser MD, Silvio Podda MD, and S. Anthony Wolfe MD, FACS Stryker Hyperguide, 2008

  4. Switch Cranioplasty and BMP-2 in a Hemicranial Reconstruction in an Infant. S. Podda, F. Ciminello, and S.A. Wolfe Craniofacial Surgery (12); pp 77-82, 2008

  5. Distraction Osteogenesis of the Cleft Maxilla. Granger B. Wong MD, DMD, FACS, Frank S. Ciminello MD, and Bonnie L. Padwa DMD, MD Facial Plastic Surgery, Vol 24(4); pp 467-471, 2008

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