Cleft Lips and Cleft Palates: More Than a Cosmetic Problem

Reviewed by Operation Smile

Cleft lips and cleft palates are congenital abnormalities that affect childrens' ability to eat speak, hear, breath and socialize. In fact, ear infections and dental problems including missing or extra teeth, and cavities, occur more frequently among children with clefts. Although these birth defects can be debilitating, the good news is that reconstructive plastic surgery can help restore normal function among children born with cleft lips or cleft palates, also improving appearance and self-confidence.

What Are Clefts?

A cleft lip is marked by an opening in the upper lip between a newborn's mouth and nose. There may also be an opening in the bones of the upper jaw and/or upper gumline.

A cleft palate occurs when the roof of the mouth (hard palate) has an opening in it. The severity of clefts tends to vary and can involve one or both sides of the face, occurring individually or together.

Clefts occur in approximately one per 500 to 700 births, according to the World Health Organization International Collaborative Research on Craniofacial Anomalies. These conditions can be detected during routine prenatal screening, but if they are not picked up during pregnancy, they are visible at birth.

Cleft lips and cleft palates are common in developing nations where many families are too poor to afford the reconstructive surgeries needed for corrective treatment. In the U.S. and Europe, however, it is rare to see someone with a cleft lip or palate because the defects are repaired soon after birth.

What Causes Cleft Development?

The exact nature of cleft occurrence is unknown, but it is believed the defects are likely the result of genetic and environmental factors.

For example, if one child in a family is born with a cleft lip or cleft palate, the risk increases by two-to-four percent that future children in the family will also have one. Maternal illness, smoking or consuming alcohol during pregnancy and malnutrition are examples of environmental factors that may work in tandem with genetics to increase risk of cleft lip or cleft palate.

In addition, clefts are known to occur more frequently among Asian, Latino and Native American children. Clefts occur less frequently in African Americans.

Cleft Lip and Cleft Palate Repair Surgery: What Is Involved?

If a baby is born with a cleft lip or cleft palate, a team of specialists is called in to evaluate the condition and develop a treatment plan. The plan may include surgery, speech therapy and dental work. The team may include a plastic surgeon, pediatrician, pediatric dentist, an ear, nose, and throat specialist, an audiologist, a speech therapist, genetic counselor and/or a social worker.

Ear infections tend to occur more frequently in children with clefts because their Eustachian tubes – which connect the middle ear to the throat – don't drain fluid properly. As a result, fluid accumulates, pressure builds and ear infection can develop. For this reason, children with clefts may have special tubes surgically inserted into their ears at the time of their first reconstructive surgery.

A cleft palate can make it more difficult for a child to suck on a nipple and may cause formula or breast milk to be accidentally taken up into the nasal cavity. Your surgeon may suggest that your child use an obturator before surgery. This device is placed inside the mouth and can help with feeding and maintaining the arch of the lip prior to surgery.

As a general rule, cleft lips should be repaired by the time a baby is three months old. Cleft palate repair is typically done between the ages of 12 and 18 months because performing the surgery any earlier may compromise facial growth. Later surgeries, however, may affect speech.

General anesthesia will be used during your child's cleft repair surgery. The surgeon strives to close the separation in the lip by making incisions on either side of the cleft to create flaps of tissue. These flaps are drawn together and stitched to close the cleft lip.

Cleft palate repair surgery involves repositioning of tissue and muscles to close the cleft and rebuild the roof of the mouth. The surgeon makes incisions on either side of the cleft, then creates flaps to reposition muscle and the hard and soft components of the palate. The reconstructed palate is then stitched at the midline of the roof of the mouth. The goal is to provide enough length of the palate to allow for normal feeding and speech development, and continued growth throughout life.

Both surgeries take approximately 45 minutes to perform.

Cleft Repair Surgery Recovery and Results

Following either surgery, postoperative dressings or bandages are placed in the incisions. Your doctor will talk to you about how to clean the surgical site, and will likely prescribe some medications to reduce your child's risk of infection and help alleviate any pain.

Since these surgeries are mainly performed on infants, there will also be special feeding instructions. In some cases, arm restraints may be needed to prevent your child from harming the surgical site as it heals.

The healing process spans several weeks.

Cost of Cleft Lip and Cleft Palate Repair Surgery

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Cleft surgery changes lives one smile at a time.
Photos courtesy of Operation Smile

Many health insurance plans cover cleft surgery. However, always check with your provider to see what is or isn't covered before committing to a surgery and a treatment plan. Some insurers require pre-certification. It is also important to see what ancillary services are covered; such as speech therapy that may be needed following surgery.

Organizations such as Operation Smile are helping to improve access to these surgeries among children in developing nations. Operation Smile is able to transform children's lives with a 45 minute surgery that costs as little as $240.

About Operation Smile

Founded in 1982, Operation Smile, headquartered in Norfolk, Virginia, is a worldwide children's medical charity whose network of global volunteers are dedicated to helping improve the health and lives of children and young adults. Since its founding, Operation Smile volunteers have treated more than 130,000 children born with cleft lips, cleft palates and other facial deformities, and the organization has a presence in 51 countries. In addition to contributing free medical treatment, Operation Smile trains local medical professionals in its partner countries and leaves behind crucial equipment to lay the groundwork for long-term self-sufficiency. To learn more, visit www.operationsmile.org

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