Cleft Lip / Palate

Caring for a child born with a cleft palate or another congenital deformity can be emotionally taxing and stressful for a family, but through surgery and the correct treatments, it is possible for him or her to grow into a perfectly healthy adult.

Cleft Lip

What is a cleft palate and what is a cleft lip?

These are the common terms used to refer to a cleft which can occur in either the lip and/or palate of a child. Cleft palate causes are a complex result of environmental and genetic factors during pregnancy. It can occur once in perhaps every 700 births, and it is an affliction which can affect both sexes and all ethnic groups.

The three major types:
  • A cleft lip – which is either complete or incomplete and either unilateral or bilateral, which means it affects one side of the lip or both sides simultaneously. Surgery can be performed between three and six months after birth and involves stitching the skin of the lip together.
  • A cleft palate – this is when the palate cleft affects parts of the soft palate and extends into the hard palate and the gum. The corrective surgical procedure can be performed between four and 12 months after birth and involves repairing the area in layers. First the soft palate muscles are reconstructed to aid better speech and swallowing functions, then the gap in the gum is closed. If needed, there may be follow up adjustment surgery after this procedure.
  • A lip cleft and palate cleft – is a unilateral or bilateral cleft that runs from the base of the nose through the gums and palate. It is possible for this to occur while the nose and gum remain joined. Surgical procedures for this involve a combination of the above two.

Surgery is the only way to repair these malformations and is normally performed under general anaesthesia. Your surgeon will provide information on what to expect from the operation, how to treat your baby pre and post op, as well as give you advice on the best methods of feeding your baby while he or she is recovering from a cleft palate or lip surgery.

Can a Cleft Lip and Palate Be Repaired?

A cleft lip and a cleft palate are birth defects that continue to affect many children all over the world. For sufferers and their families, these deformities can cause a lot of emotional strain. But the good news is that cleft lips and cleft palates can be fixed with surgery, which allows children born with these conditions to grow up to become happy and healthy adults.

Surgery for cleft lip

This is often done when a child is between three and six months old. Patients may have a minor cleft or one that stretches to the base of the nose. A cleft may also be bilateral, affecting both sides of the lip, or unilateral, affecting one sides. Surgeons stitch the lip carefully together and trim away unnecessary tissue.

Surgery for cleft palate

Surgery on a cleft palate is generally performed when a child is between four months and one year old. Sufferers often have a split running backwards from the front gum along the hard palate. Sometimes the soft palate is also affected. Surgeons repair the cleft by starting with the soft palate and then moving onto the hard palate. Finally, the opening in the gum is closed. On some occasions, further surgery is needed to make adjustments.

Surgery for combined cleft lip and cleft palate

In an extreme case, a child will have a lip cleft that continues through the gums and palate. When this happens, surgery will consist of a combination of both of the above procedures.

During all of these operations, patients are given general anesthetic. Prior to surgery, medical professionals will give parents enough information so that they know exactly what the operation involves and what results to expect. In addition to this, parents will be informed on how to care for their child before and after the operation, as well as how to feed their child while he or she is recovering from cleft lip or cleft palate surgery.

What causes cleft lip and cleft palate

As the scientific world continues to discover more about cleft lip and cleft palate causes, it is estimated that these deformities occur at least once in every 700 births. This makes cleft lip and cleft palate some of the most common birth defects affecting children today.
What is a cleft palate and what is a cleft lip?
A cleft palate forms early on during pregnancy when the roof of a baby’s mouth doesn’t close properly. This results in an opening, known as the cleft, which extends from the front of the mouth in a backward direction along the hard palate. Sometimes the cleft can affect the soft palate as well. A cleft lip is similar in that it also forms during the early stages of pregnancy. In this case, the front upper lip fails to form completely, resulting in a split in the tissue. This opening can stretch right up to the base of nose, and can also affect one or both sides of the lip area. In extreme cases, a child may suffer from both a cleft lip and cleft palate. When this happens, the child is left with an opening that runs from the bottom of the nose all the way through the gums and palate.
What causes cleft lips and cleft palates?
Scientists have found that there are certain genes that make a baby more likely to develop a cleft than other babies, resulting in cleft lips and palates often running in families.
Together with this, the following factors can also increase the chances of a cleft forming:
  • Mother smokes while pregnant
  • Mother drinks alcohol or takes drugs during pregnancy
  • Pregnant mother has a lack of folic acid in her diet
  • Mother is extremely overweight
While scientists continue to learn more every day, the positive news is that surgeons can repair clefts, no matter what the cleft lip and cleft palate causes may be. As a result, sufferers have the chance to become healthy adults.

What to Expect after Cleft Lip Surgery

After cleft lip surgery, the main aim is to ensure that the repaired area stays protected until it has fully healed. In order to do this, various short-term changes will need to be made to your child’s feeding and sleeping habits, while your surgeon will show you how to care for the surgical wound.

After the operation, an IV will be used to provide your child with enough fluids until his or her drinking improves. Children generally stay one night in the hospital and leave as soon as they are able to consume a suitable amount of fluids.

When it comes to feeding, younger children will not be able to suck on a bottle or nipple for roughly 10 days after surgery. Instead, they will initially be given clear liquids using a syringe until they are able to tolerate their regular formula. Older children, on the other hand, may drink blended food from a cup.

When sleeping, your child will also need to lie on his or her back or side for a few days after surgery. This will help keep the repaired area from rubbing against the bed.

Most importantly, the stitches must be cleaned to prevent infection. Cleaning, which is often done after your child has eaten, involves dipping an earbud in mild soapy water and gently rolling it along the line of stitches. Afterwards, another earbud is soaked in warm water and is used to rinse the stitched area. Additionally, doctors might also want you to apply an anti-bacterial ointment as well.

Apart from regularly cleaning the repaired area, gentle restraints will be used for around 10 days or so to ensure that your child does not rub his or her face, as this would hinder the healing process. It is also better for younger children not to use a dummy until the wound has healed completely.

Throughout the recovery stage, there will be a number of follow ups with your surgeon.  Generally, the first meeting occurs between 5 and 7 days after the cleft lip surgery has taken place. After that, the next visit occurs in about 2 weeks.