What problems are associated with cleft lip and/or cleft palate?
- Eating problems : With a separation or opening in the palate, food and liquids can pass from the mouth back through the nose. Usually, babies quickly learn how to eat and feeding is not a problem.
- Ear infections and hearing loss : Children with cleft palate are at increased risk of ear infections since they are more prone to fluid buildup in the middle ear. If they are not treated, ear infections can cause hearing loss.
- Speech problems : Children with cleft palate may also have trouble speaking. These children’s voices don’t carry well, the voice may take on a nasal sound, and the speech may be difficult to understand after palate repair. Not all children have these problems, and surgery may fix these problems entirely.
Dental problems : Children with clefts are prone to many dental problems, including:
- A greater number of cavities;
- Missing, extra, malformed or displaced teeth that need to be treated.
- A defect of the alveolar ridge, the bony upper gum that contains the teeth. A defect in the alveolus can: displace, tip, or rotate permanent teeth; prevent permanent teeth from appearing; prevent the alveolar ridge from forming; and, cause premature loss of erupting canine and incisor teeth.
Who treats children who have cleft lip and/or palate?
Because of the number of oral health and medical problems associated with a cleft lip or cleft palate, a team of doctors and other specialists usually works together to develop a plan of care for each patient. Members of a cleft lip and palate team usually include:
- Plastic surgeon to evaluate and perform necessary surgeries on the lip and/or palate.
- Orthodontist to straighten and reposition teeth.
- Dentist to perform routine dental care.
- Prosthodontist to make artificial teeth and dental appliances to improve the appearance and to make the changes needed for eating and speaking.
- Speech pathologist to assess speech and feeding problems.
- Otolaryngologist (an ear, nose and throat doctor) to evaluate hearing problems and consider treatment options for hearing problems.
- Audiologist (a specialist in hearing disorders) to check and monitor hearing.
- Nurse coordinator to provide ongoing supervision of the child’s health.
- Social worker/psychologist to support the family and take note of any adjustment problems.
- Geneticist to help parents and adult patients understand the chances of having more children with these conditions.
Treatment usually begins in infancy and often continues through early adulthood.
How are cleft lip and palate treated?
A cleft lip may require 1 or 2 surgeries, depending on the extent (complete or incomplete) and width (narrow or wide) of the cleft. The first surgery is usually performed by the time a baby is 3 months old.
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.
The first surgery, to close the lip, usually occurs when the baby is between 3 and 6 months old. The second surgery, if necessary, is usually done when the child is 6 months old.
Repair of a cleft palate is performed at 12 months and creates a working palate and reduces the chances that fluid will develop in the middle ears. To prevent fluid buildup in the middle ear, children with cleft palate usually need special tubes placed in the eardrums to aid fluid drainage, and their hearing needs to be checked once a year. This is often done at the time of palate repair.
About 30-40 percent of children with a cleft palate need further surgeries to help improve their speech. Speech is usually assessed between ages 4 and 5. Often a nasopharyngeal scope is performed to check the movement of the palate and throat. A decision is then made, together with the speech pathologist, if surgery is needed to improve the speech. This surgery is usually performed around age 5.
Children with a cleft involving the gum line may also need a bone graft when they are about 6-10 years old to fill in the upper gum line so that it can support permanent teeth and stabilize the upper jaw. Once the permanent teeth grow in, a child will often need braces to straighten the teeth and a palate expander to widen the palate.
Additional surgeries may be performed to improve the appearance of the lip and nose, close openings between the mouth and nose, help breathing, and stabilize and straighten the jaw.