Cleft Lip and Palate Newport Beach
Cleft lip and palate occurs when the roof of the mouth does not completely close during the first trimester of fetal development, resulting in a gap. Because the lip and palate develop separately, it is possible for an infant to have only a cleft lip, only a cleft palate, or both a cleft lip and palate. For the cleft lip, the size of the cleft may range from a small notch in the upper lip to an opening that extends into the base of the nose. A cleft palate may involve only the hard palate, only the soft palate, or a combination of both hard and soft palate. Both a cleft lip and cleft palate may involve only one side or both sides.
The cause of clefting is multi-factorial and probably involves a combination of genetic and environmental factors; however, the exact cause of clefting is usually unknown. Environmental factors such as smoking and alcohol use during pregnancy, poor maternal nutrition, and use of certain medications, may increase the risk of clefting. Many mothers who have a baby born with a cleft have a normal pregnancy.
The incidence of cleft lip with or without cleft palate is estimated to be between 1 in 300 to 1 in 2500 births, depending on the patient’s ethnic origin. It is most common in Native Americans and Asians and least common in African Americans. Cleft palate by itself occurs in 1 in 1000 births. Cleft lip occurs more frequently in males, and cleft palate occurs more frequently in females. The majority of children born with cleft lip and/or palate are otherwise normal with no associated syndromes.
A cleft lip can sometimes be diagnosed on prenatal ultrasound. An examination of the nose, lip, and mouth confirms the presence of a cleft lip and/or palate.
Parents who have a baby with a cleft lip and palate who have a family history of clefts can consult a genetic counselor to discuss the risk of having future children with a cleft. If two unaffected parents have a child with a cleft lip and palate or isolated cleft palate, their chance of having another child with a cleft is 3-5%. If either parent has a cleft lip and palate or isolated cleft palate, but no affected children, the risk of having a child with cleft is 5%. If more than one parent and/or child have a cleft, the risk for future offspring with cleft is greater.
Children with only a cleft lip frequently have no other problems. Children with a cleft palate may have ear infections and hearing loss, dental problems, and difficulty with feeding and speech. An experienced cleft lip and palate medical team has specialists to help with each of these potential problems.
A child with a cleft palate can have difficulty sucking through a regular nipple due to the gap in the roof of the mouth. Most babies require a modified or special nipple to properly feed. It may take a couple of days for baby and parents to adjust to using the nipple before going home. Most babies learn to feed normally with a cleft palate nipple. The pediatrician and cleft team will keep close track of the child’s weight. Most babies with a cleft palate cannot generate enough suck to breast-feed. To take advantage of the health benefits of breast milk, many mothers elect to feed their baby breast milk in a bottle with a cleft palate nipple. The hospital nursery and cleft team have feeding specialists available to evaluate the baby and meet with the parents before going home.
Any child with a cleft palate is at risk of developing frequent ear infections. This occurs because the eustachian tube, located in the middle ear, does not drain properly, leading to fluid build-up and infection. Repeat ear infections and fluid retention leads to scarring of the eardrums and potential hearing loss. Pressure equalizing ear tubes can be inserted at the time of lip or palate repair to drain the middle ear and reduce the risk of ear infection and hearing loss.
A child with a cleft palate or a cleft through the gum line may have missing or abnormally shaped baby and permanent teeth. In addition, the upper jaw may not grow as far forward as the lower jaw, necessitating corrective surgery during the teenage years. These dental and jaw problems can be successfully treated by dental and orthodontic experts.
Children with an unrepaired cleft palate can also have a nasal quality to their speech because air escapes through the gap in the roof of the mouth and out the nose. These children may also have difficulty generating enough air pressure to produce certain sounds. After cleft palate repair, most children develop near normal speech. Some children will require speech therapy or another surgery when they are older to improve persistent nasal speech.
The care of the child with cleft lip and/or palate begins at birth with accurate diagnosis, identification of the child’s needs, and the allocation of a treatment center and team. The cleft team may consist of a plastic surgeon, speech therapist, dentist, orthodontist, otolaryngologist, audiologist, geneticist, pediatrician, nursing staff, social worker, psychologist, and nutritionist. Team members will work closely with you and your child to determine the best treatment plan.
The cleft lip is usually repaired between 2 to 3 months. The cleft palate is repaired six months later at eight or nine months. Some children may require a two-stage lip repair or nasoalveolar molding device placed soon after birth if the cleft is wide. If necessary, ear tubes are placed at the time of palate surgery to facilitate drainage of fluid and prevent ear infections.
Secondary surgeries such as cleft lip revision, cleft palate fistula repair, alveolar bone grafting, pharyngeal flap, rhinoplasty, and orthognathic jaw surgery may be needed and recommended by your pediatric plastic surgeon at different times during childhood.