Cleft Lip and Cleft Palate
Cleft lip and cleft palate are among the most common congenital (present at birth) facial differences in children. These conditions occur in 1 out of 700 births. Cleft lip and cleft palate occur when the tissues and bone of the face and mouth do not fuse properly, resulting in a space in the upper lip and/or roof of the mouth.
Cleft Lip and Cleft Palate Causes
The exact causes of cleft lip and cleft palate are not completely understood. Most cases of cleft lip and palate occur by chance. In some cases, the condition may be may be genetic, or inherited. Research suggests that some cases occur due to a combination of genetic and environmental factors affecting the mother during pregnancy — including smoking, diabetes or the use of certain medications — could be connected. Genetic consultation may be suggested.
Cleft palate may be associated with Pierre Robin syndrome, a birth defect characterized by a small jaw, glossoptosis (a floppy tongue), and airway obstruction that may need surgical treatment.
Cleft Lip and Cleft Palate Complications
Beyond the facial differences caused by cleft lip, other possible concerns that may be associated with cleft lip and cleft palate include:
- Feeding difficulties. Feeding difficulties occur more with cleft palate. The infant may be unable to suck properly because the roof of the mouth is not fully formed.
- Ear infections and hearing loss. Ear infections are often due to a dysfunction of the tube that connects the middle ear and the throat. Recurrent infections can lead to hearing loss.
- Speech and language dysfunction. Due to the opening in the roof of the mouth, muscle function may be affected, which can lead to abnormal speech. Ask your doctor if consultation with a speech therapist would be right for your child.
- Dental problems. As a result of the facial differences, teeth may not develop normally and orthodontic treatment may be required.
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Cleft Lip and Cleft Palate Treatment
Both cleft lip and cleft palate surgeries are performed in the hospital under general anesthesia, and usually require a stay of at least one night.
Cleft Lip Surgery
For most infants with cleft lip, the child’s surgeon can repair the abnormality within the first several months of life. To repair a cleft lip, the plastic surgeon uses a special technique to repair the lip, blend scars into the natural structures of the face, and improve the shape of the nose. Lip repair surgery can be performed in multiple stages depending on the specifics of the condition.
What to expect following cleft lip surgery
Discomfort or Pain
- Children may be irritable following surgery, but will be prescribed pain medications to help with this. After two to three days, the child will feel more comfortable and should only require over-the-counter pain medications, which can be discontinued after a few additional days.
- They may have to wear padded arm restraints to prevent them from placing their hands in their mouth and injuring the surgery area. Children may have dissolving stitches or stitches that will be removed five to seven days after surgery. It is normal to have swelling, bruising and blood around the incisions.
Eating and Drinking
- During surgery and afterward, the child will have an intravenous (IV) catheter to provide them fluids until they are able to drink liquids by mouth. This is commonly only needed for less than a day after surgery.
- The care team will provide instructions on feeding the child after surgery.
Appearance
- The lip scar will gradually fade with time, but will never completely disappear. Some children will benefit from additional procedures to improve the appearance of the lip and nose later in childhood and adolescence.
Cleft Palate Surgery
Cleft palate repairs are usually done between the ages of 6 to 15 months. This is a more complicated surgery, and it is done when the baby is bigger and better able to tolerate the surgery. The child’s doctor will advise about the exact timing of the surgery. To repair a cleft palate, the plastic surgeon uses tissue from either side of the mouth to fill in the gap.
At the first visit with the plastic surgeon, they will explain the details of the surgery, risks, complications, recovery time and outcomes.
What to expect following cleft palate surgery
Discomfort or Pain
Patients may have greater discomfort following cleft palate surgery compared to cleft lip repair. Patients will be discharged home with a prescription for pain medication.
There may be bloody drainage from the nose and mouth after surgery, which will decrease in one or two days. Many infants have nasal congestion after surgery. Signs of this include snorting, mouth breathing and decreased appetite.
Eating and Drinking
The child will have an IV catheter for pain medications and fluids until they are able to drink liquids. Children will be encouraged to start drinking as soon as they are awake from their surgery. The child may stay in the hospital for one to two days depending on their feeding after surgery.
The plastic surgeon may suggest that the child continue with diet restrictions for up to four weeks after surgery. Breast milk and formula are approved to drink after surgery. For older children, appropriate foods include baby foods, popsicles, yogurt, mashed potatoes, gelatin and other foods of similar consistencies.
Stitches and Healing
The child will have stitches in the palate that will dissolve on their own. They may have to wear padded arm restraints to prevent them from placing their hands in their mouth and injuring the surgery area.
The child can walk or play calmly after surgery, but should not engage in rough play or contact sports. They should not place toys or other objects in their mouth for a month after surgery. The child’s care team will inform when it is OK for the child to return to regular activities.
