Correcting Cleft Lip or Palate

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					 Correcting Cleft Lip or Palate

The importance of a team
approach »
All surgery carries some risk »
Planning for surgery »
                                  If you're considering surgery to correct cleft lip or palate...
Cleft lip surgery »
Recovering from cleft lip surgery
                                  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
Cleft palate surgery »            normally grow together. Occasionally, however, in about one of
Recovering from cleft palate      every 800 babies, those sections don't quite meet. A child born
surgery »                         with a separation in the upper lip is said to have a cleft lip. A
The repaired lip or palate »      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

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 Correcting Cleft Lip or Palate

                                                 more information, contact The Cleft Palate Foundation, 104 S.
                                                 Estes Drive Suite 204, 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
A cleft lip is a separation of                   first operation. Occasionally, a second operation may be needed.
the upper lip that can extend
into the nose.                 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
To repair a cleft lip, the
surgeon will first make an
                                                 A cleft lip can range in severity from a slight notch in the red part
incision on each side of the
                                                 of the upper lip to a complete separation of the lip extending into
cleft from the lip to the
                                                 the nose. Clefts can occur on one or both sides of the upper lip.
nostril.
                                                 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

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                                                 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
The cleft lip is then drawn                      during the first few weeks after surgery.
together and stitched to
create a normal "cupid's     It's normal for the surgical scar to appear to get bigger and
bow" shape to the upper lip. 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.
The scar left after surgery
will gradually fade with time.
                                                 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


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                                                 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.
When the roof of the mouth
doesn't grow together                            You'll want to discuss further needs with the members of the
properly, the condition is                       Cleft Team seeing your child.
called a cleft palate. To
repair it, the surgeon will                      Perhaps most important, keep in mind that surgery to repair a
make an incision along both                      cleft lip or palate is only the beginning of the process. Family
sides of the cleft.                              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.




Tissue is drawn together
from both sides of the cleft
to rebuild the roof of the
mouth.




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