Cleft lip and palate Health Article

Treatment and management

If cleft lip and/or palate are diagnosed by ultrasound before birth, further testing may be required to diagnose associated abnormalities if present. Referral to a cleft team is essential. A cleft team consists of specialists in the management of patients with clefts and includes surgeons as well as nurses and speech therapists. Members of the team inform the parents of all aspects of management. Feeding methods are also discussed, since feeding is the first problem that must be dealt with. It may be possible to breast feed a baby born with only a cleft lip, but babies born with cleft palates usually have more problems with feeding and frequently require special bottles and teats. A palatal obturator is a device that fits into the roof of the mouth, thus blocking the cleft opening and allowing easier suckling.

Surgery to repair cleft lips is sometimes performed after orthodontic treatment to narrow the gap in the upper lip. The orthodontic treatment can involve acrylic splints with or without screws or may involve the use of adhesive tape placed across the gap in the lip. Orthodontic treatment for cleft lip should begin within the first three weeks of life and continue until the cleft lip is repaired.

The timing of surgical cleft lip repair depends on the judgement of the surgeon who will perform the operation. The procedure is usually performed between one and three months of age. The goals of the operation are to close the gap in the upper lip, place scars in the natural skin curves, and to repair muscle so that the lip appears normal during movement. The closure is done in the three layers (skin, muscle, and mucosa) that line the inside of the lip. At the time of the procedure, if the nose is shaped abnormally due to the cleft lip, it is also corrected. Sometimes further surgery may be needed on the lip and or nose to refine the result.

The goals of the surgeon repairing a cleft palate are normal speech, normal facial growth, and hearing for the affected infant. The repair of the cleft palate is usually performed between three and 18 months of age. The timing may extend beyond this and varies with the type of cleft plate and center where the procedure is being performed. Depending on the type of cleft palate, more than one operation may be needed to close the cleft and improve speech.

Nonsurgical treatment of a cleft palate is available for patients who are at high risk for surgery and consists of a prosthetic appliance worn to block the opening in the palate.

Babies born with cleft palates are vulnerable to ear infections. Their Eustachian tubes do not effectively drain fluid from the middle ear so fluid accumulates and infection sets in. This may lead to hearing loss. These children require drainage tubes to be inserted to prevent fluid accumulation.

Babies born with clefts usually require orthodontic treatment between 13 and 18 years of age. They also require speech therapy.

Prognosis

Individuals with cleft lip and palate have a good prognosis, and approximately 80% will develop normal speech. There is no known means of preventing clefting. Good prenatal care is essential and avoiding harmful substances appear to reduce the risk.

PERIODICALS

Bender, Patricia L. "Genetics of Cleft lip and Palate." Journal of Pediatric Nursing 15 (August 2000): 242-249.

Christensen, Karr. "The 20th Century Danish Facial Cleft Population–Epidemiological and Genetic-Epidemiolical Studies." Cleft Palate–Craniofacial Journal 36 (March 1999): 96-104.

Chung, Kevin C. "Maternal Cigarette Smoking during Pregnancy and the risk of having a child with Cleft Lip/Palate." Plastic and Reconstructive Surgery 105 (February 2000): 458-491.

Cockell, Anna. "Prenatal Diagnosis and Management of Orofacial Clefts." Prenatal Diagnosis 20 (February 2000): 149-151.

Denk, Michael J. "Topics in Pediatric Plastic Surgery." Pediatric Clinics of North America 45 (December 1998).

Litwak-Saleh, Kim. "Practical Points in the case of the Patient with post-Cleft lip repair." Journal of Post Anesthesia Nursing 8 (February 1993): 35-37.

Rohrich, Rod J. "Optimal Timing of Cleft Palate Closure." Plastic and Reconstructive Surgery 106 (August 2000): 413-421.

ORGANIZATIONS

Cleft Palate Foundation. (800) 24-CLEFT. <http://www.cleftline.org>.

Farris F. Gulli, MD