Cleft Lip - Cleft Palate

What is a cleft?

A cleft is a space in the lip and/or palate where early in the embryonic period the tissue did not come together in the region of the cleft, leaving this space. The majority of clefts are caused by a combination of genetic inheritance and environmental factors.

What challenges will be faced?

There are many challenges that the parents of a child with a cleft and the health care provider will face. The earliest of these problems is likely to be with feeding. Breastfeeding may be difficult or impossible. Numerous nursers have been developed to assist in the feeding of a child with a cleft. Once the baby is feeding well, growing and gaining weight, surgery to repair the cleft can be planned. The initial repair of the lip and/or palate is usually

completed in most surgeons' hands by about 18 months of age. The type and severity of the cleft will determine the number of procedures necessary during that period. It may be recommended that tubes be placed in the ear drums during one cleft repair procedures.

The abnormal appearance of the nose associated with a cleft lip usually improves significantly when the lip is repaired. However, further nasal surgery is typically required to improve the appearance

of the nose.   If the cleft passes through the gum, then a bone graft to the gum may be required later in the course of the cleft care.

Care for clefts can be quite complex, requiring the specialized skills of numerous providers. The care tends to proceed most efficiently if these providers are working together as a team. This coordinated, skilled care can lead to happy, fulfilled lives for most children born with clefts.

Understanding Cleft Lip surgery

The normal lip has three layers, a mucous membrane inside the mouth, a middle muscle layer and an outer skin layer.

Not only must the three layers of the lip be reconstructed, but the anatomical details of Cupid's bow must also be established. Another goal is to minimize the visibility of the scarring so that the repaired lip can look as natural as possible. With a cleft palate, not only is there a defect in the palate allowing a

connection between the nose and the mouth, but the soft palate is also short, and the muscles are malpositioned leading to potential problems with palate function ever after the cleft is repaired.

The goals of the surgery are to close the cleft, generally in two layers for the hard palate separating the nasal cavity from the oral cavity.