If you rub your finger over your upper lip, you'll feel the tissue that runs between your nose and lip. That groove in between is called your philtrum (say: fill-trum). Now run your tongue over the roof of your mouth. The line that is the middle, is where your palate grew together. If you open your mouth and look into a mirror you can see that the palate goes from your teeth all the way to the back of your mouth and there are no defects or holes in your palate. The word cleft means a gap or split between two things. A cleft lip is a split in the upper lip. A cleft palate is a split in the roof of the mouth. This leaves a hole between the nose and the mouth. Cleft lip, with or without cleft palate, affects 1 in 700 to 1,000 babies in the United States each year.
In addition, clefts can occur on one side of the mouth (unilateral clefting) or on both sides of the mouth (bilateral clefting).
More boys than girls have a cleft lip, while more girls have cleft palate without a cleft lip.
Because clefting causes specific visible symptoms, it's easy to diagnose. It can be detected through a prenatal ultrasound. If the clefting has not been detected prior to the baby's birth, it's identified immediately afterward.
Cleft lip and cleft palate are birth defects. In other words, this occurs during the developmental process in the womb. Normally, the mouth and nose of a baby develop between the first 6 and 12 weeks of growth. In some babies, parts of the lips and roof of the mouth don't grow together. Because the lips and the palate develop separately, it's possible to have cleft lip, cleft palate, or both.
In most cases, we simply don't know why lip and palate development go wrong. Race and gender play a small role as clefts are most common in Asians. They are less common in whites and least common in blacks. Boys are more often affected than girls.
In some families, clefts appear to be hereditary. Sometimes substances in the environment, called teratogens, may be associated with the development of clefts. But most babies with clefts have no known relatives with clefts and no known exposure to teratogens. A few babies with clefts also have other developmental abnormalities. Your baby's primary care doctor will look for these other abnormalities and tell you what he or she finds. More Cleft Lip and Cleft Palate Facts...
A child with a cleft lip or palate tends to be more susceptible to colds, ear infections, hearing loss, problems with eating, speech defects, dental problems.
Children born with a cleft lip or palate may need the skills of several medical professionals to correct the problems associated with the cleft. Medical professionals with special experience in the problems of cleft lip and palate have formed such teams all over the country to help parents plan for their child's care from birth, or even before. Members of a child's cleft lip and palate treatment team usually include:
Treatment usually begins in the first few months of an infant's life, depending on the health of the infant and the extent of the cleft.
The team specialists will evaluate your child's progress regularly, examining your child's hearing, speech, nutrition, teeth, and emotional state. They will share their recommendations with you, and can forward their evaluation to your child's school, and any speech therapists that your child may be working with. More Cleft Lip and Cleft Palate Facts...
"The Parameters for Evaluation and Treatment of Patients with Cleft Lip/Palate or Other Craniofacial Abnormalities" document summarizes the current guidelines for team care endorsed by the American Cleft Palate-Craniofacial Association. By following these guidelines, teams are promoting the best possible outcomes for children born with clefts or other craniofacial birth defects. The important factors to take into consideration include:
General agreement exists that surgical correction of a cleft palate should be accomplished when patients are younger than 1 year, before significant speech development occurs. The potential benefits of an intact palate as a child begins to speak are believed to outweigh the possible complications of early closure. Surgery for both cleft palate and a cleft lip require general anesthesia.
For Cleft lip surgery, the surgeon will make an incision on each side of the cleft from the lip to the nostril. The two sides of the lip are then sutured together. Bilateral cleft lips may be repaired in two surgeries, about a month apart, and usually requires a short hospital stay.
The goal of repair in patients with cleft palate is to separate the oral and nasal cavities; this separation involves the formation of a valve that is both watertight and airtight. The valve is necessary for normal speech. The repair also helps with preserving facial growth and the development of proper dentition. Cleft palate surgery involves drawing tissue from either side of the mouth to rebuild the palate. It requires 2 or 3 nights in the hospital, with the first night spent in the intensive care unit.
The necessity for more operations often depends on the severity of the cleft, its shape, and the thickness of available tissue that can be used to create the palate. Some children with a cleft palate require more surgeries to help improve their speech. Additional surgeries may also improve the appearance of the lip and nose, close openings between the mouth and nose, help breathing, and stabilize and realign the jaw. Subsequent surgeries are usually scheduled at least 6 months apart to allow a child time to heal and to reduce the chances of serious scarring. More Cleft Lip and Cleft Palate Facts...
Immediate postoperative concerns in cleft palate repair include airway management and pain management. Repairing the palate changes the nasal/oral airway dynamics and may present problems in the immediate postoperative period. A suture is often placed through the tongue to allow forward traction on the tongue while the patient still has an airway tube in the post-operative state. This suture is removed once the child is fully alert and able to maintain his/her own airway. In infants and younger children, arm restraints or "no-no's" are used when the child is unattended to prevent the placement of fingers in the mouth because this may disrupt the repair.
Diet in the postoperative period is generally limited to liquids and soft foods that do not require chewing. The use of bottles is avoided because the nipples may interfere with the repair. The use of spoons is also avoided for similar reasons. Feeding is accomplished by using either a cup (not a sipping cup) or a Breck feeder (a red rubber catheter attached to a syringe). Normal diet and feeding may be resumed after 10-14 days, depending on the type of repair. At 3 weeks, all dietary and feeding restrictions are removed. More Cleft Lip and Cleft Palate Facts...
Once discharged from the hospital, the patient should have follow-up visits at 7-10 days and at 3 weeks. If a small fistula or a wound breakdown is noted in this period, waiting at least 6 months prior to attempting closure is advised. This delay allows for maximal wound contracture and for reestablishment of the blood supply to the tissues. More Cleft Lip and Cleft Palate Facts...
Keep in mind that surgery to repair a cleft lip or palate is only the beginning of the process. Family support is critical for your child. Love and understanding will help him or her grow up with a sense of self-esteem that extends beyond the physical defect. More Cleft Lip and Cleft Palate Facts...
This information is intended only as an introduction to this procedure. This information should not be used to determine whether you will have the procedure performed nor does it guarantee results of your elective surgery. Further details regarding surgical standards and procedures should be discussed with your physician.