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Cleft Lip and Palate
At Gillette Children’s Specialty Healthcare, our Center for Craniofacial Services provides expert evaluations and treatments for cleft lip, cleft palate and associated symptoms. Led by a team of highly skilled craniofacial and plastic surgeons, our center is among the region’s largest and most comprehensive.
Our surgical and presurgical techniques maximize functional and cosmetic outcomes in even the most complex cases. With proper care, many instances of cleft lip are unrecognizable at a conversational distance.
Why Choose Gillette?
- We offer care from the region’s top experts in cleft lip and palate repair.
- Our team is researching and developing the latest craniofacial treatment techniques.
- We provide a coordinated team of pediatric experts, including craniofacial and plastic surgeons, dentists, orthodontists and speech-language pathologists.
- Our approach provides comprehensive support for associated complications, including speech delays, hearing loss and feeding issues.
- We offer bilingual speech-language pathology services in Spanish.
- We offer comprehensive treatment that begins at birth and continues throughout childhood.
Cleft lip and cleft palate occur when the sides of the lip and roof of the mouth (palate) don’t fuse as they should in the earliest stages of pregnancy. Among the most common craniofacial conditions, cleft lip and/or cleft palate affect approximately one in every 700 babies. Children can have a cleft lip, a cleft palate or both.
Types of Clefts
Because the lips and palate develop separately, it’s possible for a child to have a cleft lip, a cleft palate or both. More than 70 percent of babies born with a cleft lip also have a cleft palate.
Clefts typically occur in the upper lip and do not affect the lower lip. They can range from mild to severe. Mild clefts might resemble a notch in the lip; severe clefts can create a large opening from the lip through the nose.
Cleft lips are classified as unilateral or bilateral. In a unilateral cleft lip, a gap appears under one nostril. With a bilateral cleft lip, a gap appears under each nostril.
Cleft lips can also be complete or incomplete. A complete cleft involves the entire lip and part of the jawbone that holds the teeth. An incomplete cleft involves only part of the lip.
Cleft palates can extend from the front of the mouth (hard palate) to the throat (soft palate) and range from mild to severe. Because the palate is inside the mouth, cleft palates are less visible than cleft lips.
Causes of and Risk Factors for Clefts
In the early stages of pregnancy, separate areas of a baby’s face develop individually and then join. When facial parts don’t join properly, the result can be a cleft in the lip, palate or both. Although no one knows exactly what causes clefts, some medical specialists believe that both genetic (inherited) and environmental factors (such as medications or vitamin deficiencies) play roles.
Either parent can pass on a gene or genes that cause clefts. Biological children of a parent born with a cleft have a 4- to 6-percent chance of also having clefts. When a child has a cleft, but neither biological parent has a cleft, there’s a 2- to 8-percent chance that biological siblings of the child also will have clefts.
When a parent and a biological child both have clefts, the chances are even greater that the parent’s future children will have clefts. In some instances, cleft lip and/or palate can be associated with underlying genetic disorders that cause additional deformities and concerns elsewhere in the body.
Clefts occur more often among Asians and among certain groups of American Indians. They occur less frequently among African Americans. More males than females have clefts, and males are more likely to have both a cleft lip and a cleft palate.
Up to 13 percent of babies with clefts have additional birth abnormalities, some of which aren’t readily apparent. Genetic testing can help determine if a child’s cleft is part of an underlying condition.
Symptoms and Effects of Clefts
The most obvious symptom of cleft lip and palate is a gap in the lip or roof of the mouth. Clefts also can cause secondary and less visible complications. Gillette’s Center for Craniofacial Services offers comprehensive care to help families work through such challenges.
Infants who have cleft lips usually have few, if any, feeding problems. They might need special nipples or bottles, or their mother might need instructions in breastfeeding. Infants who have cleft palates, however, might be unable to suck properly. The severity of a cleft affects an infant’s ability to suck and obtain nourishment.
Babies with clefts might gag, choke, or aspirate milk while feeding. Our craniofacial team includes lactation specialists who can help parents of babies with clefts learn proper positioning and techniques to make feeding easier. Our lactation consultants can also advise on supplemental feedings and special bottles that make feeding easier for babies who have clefts.
Babies who have cleft palates are especially susceptible to middle-ear disease. Clefts can cause fluid to build up in the middle ear, leading to moderate hearing loss. Children who receive proper treatment in infancy and childhood, however, can avoid permanent hearing loss. Our team includes audiologists and ear, nose and throat (ENT) specialists for diagnostic testing and treatment.
Speech and Language Delays
With proper care, children who have cleft lips generally develop normal or near-normal speech. Some children with cleft palates, however, develop speech more slowly than other children do. Their words might sound nasal, and they might have difficulty producing some consonant sounds.
After cleft palate repair, most children eventually develop normal speech, although some need speech therapy or additional surgery. Our speech-language pathologists provide treatment for children with clefts who experience delays.
Children whose clefts extend into the upper gums (which contain the teeth) have unique dental problems. Some primary and permanent teeth might be missing, abnormally shaped, or out of position. Some children who have cleft palates also lack teeth. Gillette’s pediatric dentists and orthodontists provide care tailored to the needs of children who have cleft lip, cleft palate or both.
Diagnosing Cleft Lip and Palate
In some cases, an ultrasound can diagnose cleft lip and palate in utero. Our craniofacial and plastic surgeons offer prenatal consultations. We'll consult with parents about cleft lip and palate, educate them about current treatment options, provide appropriate counseling, and if parents wish, help them plan a course of treatment.
In other cases, clefts aren’t diagnosed until a baby is born. In either instance, early referral to a qualified craniofacial surgeon is vital to proper care and optimal outcomes.
Cleft lip is easily noticeable because it affects the area between the lip and nose. Because cleft palate occurs inside the mouth, it may not be visible at first. Sometimes, cleft palate isn’t diagnosed until babies experience feeding difficulties or other symptoms.
Our team consults with families as soon as they know they will be parenting a child with a cleft lip and/or palate. We meet with parents—sometimes before birth and often before a baby leaves a community hospital—to discuss treatments that support proper nutrition and growth. In addition, we consult with families considering adopting an older child who has a cleft.
Treatments for Cleft Lip and Palate
Whether a child begins treatment as an infant or at an older age, repair surgery is always necessary to correct cleft lip and cleft palate. For babies, the treatment process begins before the first surgery and usually continues into childhood.
Before surgery, our surgeons often recommend that babies wear a presurgical orthopedic (PSO) appliance—a presurgical device that results in improved outcomes. The presurgical orthopedic appliance takes advantage of the fact that cartilage molds easily during the first six weeks after birth.
The appliance brings gum segments together, reducing the gap in the mouth, stretching the lip muscles, and giving the nose a more even shape. The presurgical orthopedic appliance also improves sucking and eating abilities for some children awaiting surgery.
Like other oral retainers, the presurgical orthopedic appliance is made of acrylic and wires. We use soft acrylic for areas that touch the mouth or nose, making the appliance easier for a baby to tolerate. Our orthodontists customize and fit the appliance when a baby is about a week old. Once a month—until the first surgery takes place, at about 3 months—we make a new appliance to address growth.
Early use of an presurgical orthopedic appliance results in better surgical outcomes. In fact, estimates show that children who use presurgical appliances need 20 to 30 percent fewer reconstructive surgeries than those who don’t.
In most cases, proper presurgical treatment by a craniofacial surgeon and an orthodontist results in correction with a single surgery (rather than requiring multiple procedures over time). Undergoing fewer surgeries reduces risks and complications, such as those associated with anesthesia.
The goal of repair surgery is to close the cleft and repair associated anomalies. Ultimately, we seek to improve the child’s health and physical appearance, thereby promoting self-esteem.
- Cleft Lip Repair: Cleft lip repair normally requires only one reconstructive surgery to restore the mouth’s normal shape and muscle function. This surgery typically occurs when babies are about 3 months old. We modify the procedure for children who need bilateral cleft lip repair. Surgery to repair the nostrils takes place during the surgery, with later revisions if needed.
- Cleft Palate Repair: In cleft palate surgery, the goal is to close the opening in the roof of the mouth, enabling a child to eat solid foods and learn to speak properly. This surgery is more extensive than cleft lip surgery and typically occurs when a child is between 9 and 12 months old. Some children with cleft palates will need additional surgeries as they grow and develop to help with speech, improve the appearance of the lip and nose, close openings between the mouth and nose, and assist breathing.
Our speech-language pathologists work with children to improve speech after cleft repair surgery. We offer appointments with speech therapists who are fluent in Spanish and English. Our speech therapists collaborate with Gillette audiologists and ear, nose and throat (ENT) specialists when hearing problems occur.
Treatments for Older Children
Each year, Gillette treats children with clefts who’ve been adopted from outside the U.S. These children may undergo cleft repair surgery in childhood rather than infancy, or they might require revision of a repair that was less than optimal. For such children, we shorten the typical repair timeline in an effort to reduce the cleft’s effect on speech, dental and hearing development.
Surgery schedules vary, depending on the age of the child and the repairs needed. Most older children who have clefts will need ongoing orthodontia care while their permanent teeth come in. They’ll also need speech and language therapy to improve their speech abilities after cleft repair surgery.
Our Cleft Lip and Palate Services
Gillette’s craniofacial team works together to achieve the best possible outcomes for children who have cleft lip and/or cleft palate. Whether treatment begins in infancy or early childhood, our goal is improve a child’s physical appearance and promote self-confidence.
As one of the region’s top craniofacial centers, we provide surgical correction of cleft lip and palate, as well as comprehensive services for associated issues. With all services under one roof, we collaborate to treat all of the problems associated with cleft lip or palate. Our specialists guide families through the services they need as children grow and develop.
The following specialties and services are most often involved in caring for infants and children who have cleft lip and/or palate: