Cleft Lip and Palate

What is craniofacial surgery?

Craniofacial surgery is a sub-specialty of oral surgery that focuses on the treatment of patients who have birth defects such as cleft lip and palate. The craniofacial surgeon will work with a team that may include speech pathologists, orthodontists, and craniofacial plastic surgeons in planning treatment to correct cleft lip and palate, as well as other jaw and face abnormalities.

As a member of a craniofacial team, the craniofacial surgeon works to restore the jaw and facial structures, with the goal of restoring normal function and appearance. This includes surgical treatment of the position of the jaws, and pre- and post-operative treatment of jaw surgery.

What is a cleft lip and palate?

Cleft lip and cleft palate are facial malformations in which the parts of the face that form the upper lip and mouth remain split, instead of sealing together before birth. Similar splits can occur in the roof of the mouth, or palate.

Clefting results when there is not enough tissue in the mouth or lip area, and the tissue that’s available does not join together properly. Though the defect occurs in early fetal development, in most cases the cause is unknown. However, there appears to be a link to genetics and maternal environmental exposures during pregnancy.

Although there are certainly aesthetic considerations associated with cleft lip and palate, having this birth defect can affect people in more serious ways.

• Difficulty Eating – When there is a separation or opening in the palate, food and liquids can pass from the mouth back through the nose. While they await surgery, patients can use specially designed prosthetics to help keep fluids flowing downward toward the stomach, which ensures that they receive adequate nutrition.
• Speech Difficulties – Because the upper lip and palate are not properly formed, it may be difficult for children to speak clearly. When they do, a nasal sound may be produced. Their speech may be hard to understand, so a speech pathologist may be consulted to resolve these issues.
• Ear Infections – Cleft lip and palate can lead to a buildup of fluid in the middle ear, which leaves children with a higher risk for ear infections. If it’s not properly treated, even deafness can occur. To prevent infections, small tubes may be placed in the eardrums to facilitate fluid drainage.
• Dental Problems – Children who suffer from cleft lip and palate also often have missing, malformed, or displaced teeth, which causes a higher number of cavities and other dental and orthodontic issues.

Treatment

The treatment for cleft lip and palate is most likely surgery. This is where your craniofacial surgeon and team of specialists come in. Depending on the severity of the case, more than one surgery may be necessary.

In children, surgery for cleft lip usually takes place between three and six months of age. The treatment of a cleft palate will most likely involve several surgeries spread out over the course of 18 years (or whenever growth stops).