Cleft Lip and Palate
Clefts of the lip and/or palate are amongst the most common congenital abnormalities found in newborn babies. They occur in about 1 in 770 live births. Although a positive family history or an environmental problem such as drugs, infections or alcohol is occasionally found, in most cases no cause is identified. Folic acid at the time of conception will help prevent the formation of clefts.
Clefts may affect the lip and nose, the palate or both the lip and palate.
- Isolated cleft lip: 21%
- Isolated cleft palate: 46%
- Combined cleft lip and palate: 33%
They may be incomplete or complete and usually on one side rather than both sides.
Some may be subtle such as only a split in the muscle of the palate, but even these can cause speech problems. If you have had a child with a cleft lip or palate, the risk of having another is small.
Most children with cleft lip and/or palate can be expected to grow into normal children. Early problems with feeding can be treated with appropriate advice and the correct method of feeding.
Surgery for cleft lip is done at 3-6 months of age and surgery for cleft palate at 6 months. If a combined cleft lip and palate is present then surgery is done at 6 months of age in one stage and I try to repair both the lip and palate. Sometimes the cleft is too wide to allow this to be done without causing other problems and then I will repair the lip and soft palate and do a second stage for the hard palate 6 months later. We try to perform all primary surgery under a year of age.
Children may require secondary surgery later. Touch ups may be required to improve the lip, and if so, this is done around school starting age. The alveolus is that part of the gum which holds the teeth and if this is cleft then we put bone grafts in around the age of 11 years. Final rhinoplasty can be done in late teenage years and any jaw surgery in early adulthood.
With cleft lip repair we are trying to attain a normal looking lip and nose. Of course there will always be a scar, but otherwise the goal is to attain all the natural curves in the lip and symmetry as much as possible.
The goal with cleft palate repair is to have a repair without a hole (called a fistula) and to achieve normal speech. If a fistula occurs and this is causing problems then further surgery may be required to close it. If the speech has a nasal quality and is difficult to understand, then further surgery may be required to help with that.
Follow up and team care
Because children are growing and changing we like to see children every year or two to make sure that all is well. Optimal cleft care is provided by a team and I work closely with a speech therapist, orthodontist, paediatric dentist, child psychologist, other plastic surgeons, paediatric anaesthetists, ENT surgeons and maxillo facial surgeons.