Physician: Cleft Lip - Cleft Palate

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My child was born with a cleft lip/palate deformity, what do I need to know?


Cleft lip or palate is a facial defect causing a cleft that is either unilateral or bilateral. It is easily corrected surgically, and with special services like speech therapy, occupational therapy and a team approach these children do very well with complete recovery.

A facial cleft can occur in many different circumstances. It can be an isolated abnormality or part of a more generalized syndrome. It is imperative that a physician evaluates this child and determines if this cleft is nonsyndromic or syndromic and is associated with something more serious.

In the past the nonsyndromic cleft was considered the classic form with a genetic inheritance. Because genes are involved, the chance for a cleft lip and/or cleft palate to happen again in a family is increased, depending on how many people in the family have a cleft lip and/or cleft palate


The syndromic form may occur in a wide array of syndromes associated with (environmental, chromosomal, single-gene or unknown reasons.) These children usually have many other medical conditions associated with the cleft.

Environmental

  • Maternal seizures with anti-seizure medication usage (CL/CP)
  • Fetal alcohol syndrome (CP)
  • Amniotic band syndrome (CL/CP)
  • Chromosomal
  • Trisomies (CL/CP)
  • Single Gene disorders
  • Treacher Collins syndrome (CP)
  • Cornelia de Lange Syndrome (CP)

Facial clefts are usually associated with the following problems:

  1. Early feeding difficulties
  2. Recurrent ear infections
  3. Hearing and language delay
  4. Speech problems
  5. Hyper nasality and articulation errors
  6. Dental and orthodontic complications

The skills of many different specialties are needed to help with the problems that can occur with cleft abnormalities.

The following are some of the members of the team:

  1. plastic/craniofacial surgeon
  2. pediatrician
  3. orthodontist
  4. pediatric dentist
  5. speech and language specialist
  6. otolaryngologist (ear-nose-throat specialist)
  7. audiologist (hearing specialist)
  8. genetic counselor
  9. nurse team coordinator
  10. social worker

Treatment for cleft lip and cleft palate: Treatment for these abnormalities includes surgery and a complete team approach to help with the multiple complications that can occur. Specific treatment will be determined by your child's age, overall health, and medical history, specific qualities of your child's abnormality.

For most infants with cleft lip alone, the abnormality can be repaired within the first several months of life (usually when the baby is 10 to 12 pounds. The goal of this surgery is to correct the separation of the lip. Sometimes, a second operation is needed.

Cleft palate repairs are usually done between the ages of 9 and 18 months but before the age of 2. This is a more complicated surgery and is done when the baby is bigger and better able to tolerate the surgery. The goal of this surgery is to repair the roof of the mouth so that your child can eat and learn to talk normally. Sometimes, a second operation is needed.

After the surgery for cleft lip: Your child may be irritable following surgery. Your child may also have to wear padded restraints on his/her elbows to prevent him/her from rubbing at the stitches and surgery site.

Stitches either will dissolve on their own or will be removed in approximately five to seven days. Specific instructions will be given regarding how to feed your child after the surgery. The scar will gradually fade, but it will never completely disappear.

After the surgery for cleft palate: This surgery is usually more involved and can cause more discomfort and pain for the child than cleft lip surgery. As a result of the pain and the location of the surgery, your child may not eat and drink as usual. The child may require intravenous fluids until he/she can drink adequately.

Your child will have stitches on the palate where the cleft was repaired. The stitches will dissolve after several days.

There may be some bloody drainage coming from the nose and mouth.

There will be some swelling at the surgery site.

For two to three days, your child will feel mild pain that can be relieved by a non-aspirin pain medication. Many infants show signs of nasal congestion after surgery. These signs may include nasal snorting, mouth breathing, and decreased appetite. Your child will be on antibiotics to prevent infection while in the hospital.

Diet after surgery: The child should be placed on a soft diet for seven to 10 days after surgery. For older infants and children, age-appropriate soft foods may include strained baby foods, Popsicles, yogurt, mashed potatoes, and gelatin.

Activity after surgery: Your child can walk or play calmly after surgery. He/she should not run or engage in rough play (wrestling, climbing) or play with "mouth toys" for one to two weeks after surgery.

by George Rogu M.D.

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Disclaimer

The information and advice provided is intended to be general information, NOT as advice on how to deal with a particular child's situation and or problem. If your child has a specific problem you need to ask your pediatrician about it - only after a careful history and physical exam can a medical diagnosis and/or treatment plan be made. This Web site does not constitute a physician-patient relationship.

This material has been provided by AdoptionDoctors.com, an innovative adoption medicine private practice and educational service, dedicated to helping parents and adoption agencies with the complex pre-adoption medical issues of internationally adopted children. All medical interactions are performed via, e-mail, express mail, telephone, and fax. There is no need to make a live appointment or travel outside of your hometown. For more information, visit AdoptionDoctors.com or call 631-499-4114.

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