If You're Considering Surgery to Correct Cleft Lip or Palate...
In
the early weeks of development, long before a child is born, the right
and left sides of the lip and the roof of the mouth normally grow
together. Occasionally, however, in about one of every 800 babies,
those sections don't quite meet. A child born with a separation in the
upper lip is said to have a cleft lip. A similar birth defect in the
roof of the mouth, or palate, is called a cleft palate. Since the lip
and the palate develop separately, it is possible for a child to have a
cleft lip, a cleft palate, or variations of both.
If your child
was born with either or both of these conditions, your doctor will
probably recommend surgery to repair it. Medical professionals have
made great advances in treating children with clefts and can do a lot
to help your child lead a normal, healthy, happy life.
This
information will give you a basic understanding of the operation --
when it can help, how it's performed, and what results you can expect.
It can't answer all of your questions, since a lot depends on you
individual circumstances. Please be sure to ask your surgeon if there
is anything you don't understand about the procedure.
The Importance of a Team Approach
Children
born with a cleft lip or palate may need the skills of several medical
professionals to correct the problems associated with the cleft. In
addition to needing plastic surgery to repair the opening, these
children may have problems with their feeding and their teeth, their
hearing, their speech, and their psychological development as they grow
up.
For that reason, parents should seek the help of a Cleft Lip
and Palate Team as early as possible. 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. Typically, a Cleft Team might include
a plastic surgeon, a pediatrician, a dentist, a speech and language
specialist, a social worker, a hearing specialist, an ear-nose-throat
specialist, a psychologist, a nurse, and a genetic counselor.
Ask your doctor for a referral to a Cleft Team in your area. Or, for more information, contact The Cleft Palate Foundation, 1504 East Franklin Street, Suite 102, Chapel Hill, NC 27514, (telephone: 800-24CLEFT).
All Surgery Carries Some Uncertainty and Risk
When
surgery is done by a qualified plastic surgeon with experience in
repairing cleft lip or palate, the results can be quite positive.
Nevertheless, as with any operation, there are risks associated with
surgery and specific complications associated with this procedure.
In
cleft lip surgery, the most common problem is asymmetry, when one side
of the mouth and nose does not match the other side. The goal of cleft
lip surgery is to close the separation in the first operation.
Occasionally, a second operation may be needed.
In cleft palate
surgery, the goal is to close the opening in the roof of the mouth so
the child can eat and learn to speak properly. Occasionally, poor
healing in the palate or poor speech may require a second operation.
Planning For Surgery
At
your initial consultation, your doctor will discuss the details of the
procedure he or she will use, including where the surgery will be
performed, the type of anesthesia to be used, possible risks and
complications, recovery, costs, and the results you can expect. Your
surgeon will also answer any questions you may have about feeding your
baby, by breast or by bottle, both before and after the surgery.
In
most cases, health insurance policies will cover most or all of the
cost of cleft lip or cleft palate surgery. Check your policy to make
sure your child is covered and to see if there are any limitations on
what types of treatment are covered.
Cleft Lip Surgery
A
cleft lip can range in severity from a slight notch in the red part of
the upper lip to a complete separation of the lip extending into the
nose. Clefts can occur on one or both sides of the upper lip. Surgery
is generally done when the child is about 10 weeks old.
To repair
a cleft lip, the surgeon will make an incision on either side of the
cleft from the mouth into the nostril. He or she will then turn the
dark pink outer portion of the cleft down and pull the muscle and the
skin of the lip together to close the separation. Muscle function and
the normal "cupid's bow" shape of the mouth are restored. The nostril
deformity often associated with cleft lip may also be improved at the
time of lip repair or in a later surgery.
Recovering From Cleft Lip Surgery
Your
child may be restless for awhile after surgery, but your doctor can
prescribe medication to relieve any discomfort. Elbow restraints may be
necessary for a few weeks to prevent your baby from rubbing the
stitched area.
If dressings have been used, they'll be removed
within a day or two, and the stitches will either dissolve or be
removed within five days. Your doctor will advise you on how to feed
your child during the first few weeks after surgery.
It's normal
for the surgical scar to appear to get bigger and redder for a few
weeks after surgery. This will gradually fade, although the scar will
never totally disappear. In many children, however, it's barely
noticeable because of the shadows formed by the nose and upper lip.
Cleft Palate Surgery
In
some children, a cleft palate may involve only a tiny portion at the
back of the roof of the mouth; for others, it can mean a complete
separation that extends from front to back. Just as in cleft lip, cleft
palate may appear on one or both sides of the upper mouth. However,
repairing a cleft palate involves more extensive surgery and is usually
done when the child is nine to 18 months old, so the baby is bigger and
better able to tolerate surgery.
To repair a cleft palate, the
surgeon will make an incision on both sides of the separation, moving
tissue from each side of the cleft to the center or midline of the roof
of the mouth. This rebuilds the palate, joining muscle together and
providing enough length in the palate so the child can eat and learn to
speak properly.
Recovering From Cleft Palate Surgery
For
a day or two, your child will probably feel some soreness and pain,
which is easily controlled by medication. During this period, you child
will not eat or drink as much as usual -- so an intravenous line will
be used to maintain fluid levels. Elbow restraints may be used to
prevent your baby from rubbing the repaired area. Your doctor will
advise you on how to feed your child during the first few weeks after
surgery. It's crucial that you follow your doctor's advice on feeding
to allow the palate to heal properly.
The Repaired Lip or Palate
Children
with a cleft palate are particularly prone to ear infections because
the cleft can interfere with the function of the middle ear. To permit
proper drainage and air circulation, the ear-nose-and-throat surgeon on
the Cleft Palate Team may recommend that a small plastic ventilation
tube be inserted in the eardrum. This relatively minor operation may be
done later or at the time of the cleft repair. In addition, surgery may
be recommended by your plastic surgeon when your child is older to
refine the shape and function of the lip, nose, gums, and palate.
You'll want to discuss further needs with the members of the Cleft Team seeing your child.
Perhaps
most important, 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.