Cleft Lip & Palate Surgery
The Maxillofacial team at SPARSH has special interests in treatment of congenital anomalies. The surgeons have received special training in managing such deformities. The team is dedicated in establishing an excellent and finest unit in the country, if not the world, to manage such cases. Team members are not only passionate in treating such cases but also involved in various research activities, and constantly undergo training in higher centres to upgrade their skills and keep in touch with the newer techniques.
Frequently asked questions about cleft lip and palate
What causes cleft lips and palate?
Cleft lips and palates happen when there isn’t proper closure of the facial structure during growth of a foetus. The parts of the face and mouth develop separately, but ordinarily come together in the early months of foetal life. If for some reason the process is interrupted, the fusing may not take place or only partially take place. It is not known at this time why interruption in the fusing process happens.
For a small percentage of children born with cleft lip/cleft palate there may be a genetic factor. If one parent or child in a family has a cleft, the chances of a future child being born with a cleft increases.
What is the best way to feed a new baby with a cleft?
In the initial days feeding may be a challenge. A baby with a cleft may have difficulty making a tight seal around the nipple of a bottle or breast, and the baby with a cleft palate often cannot generate an effective suck.
There are special bottles and nipples which help to make the feeding easier. Some mothers planning breast feeding may decide to pump and use a bottle until the surgical repair has taken place.
Infants with cleft lip and/or palate may have longer feeding times which can cause them to get tired; they may swallow air with feeding. Sometimes breast milk or formula may come out of the nose, but being aware of this you can experiment with positioning and some of the bottles available.
When will my baby/child have surgery?
Cleft lips are usually repaired within the first three months after birth or when the baby weighs at least ten pounds. Cleft palates are usually repaired at nine to twelve months of age.
A consultation visit with our maxillofacial surgeon soon after birth will give parents full details about the procedure and scheduling surgery.
Will my child need any further treatment for the teeth?
Nearly all children with cleft palate need braces because the teeth closest to the cleft tend to come in at incorrect angles or not at all. Orthodontics may begin as early as age 5 or 6.
In some older children a “bone graft” is needed to allow the adult teeth to come in properly. Small bone fragments are taken from the hip and placed in the gap in the alveolus (bone edges of the gum) by an oral surgeon. This allows the adult teeth to have a solid surface to erupt into. The orthodontist and the oral surgeon will determine if this is necessary sometime between ages 8 and 10.
What is Cleft lip/palate clinic and when is the first visit?
Treatment of cleft lip and palate is multidisciplinary
The team includes:
- Maxillofacial surgeons- perform reconstructive and cosmetic surgery. treats the mouth, jaws and face
- Orthodontist – treats misaligned teeth
- Speech pathologist – evaluates and treats speech, language, voice, swallowing, fluency, and other related disorders
- Geneticist – diagnoses, treats, and counsels patients with genetic disorders or syndromes
- Audiologist – diagnoses and treatment of hearing problems
- Social worker – performs casework and counselling
- Nurses – coordinates care, clinic visits, provides support and information
All have many years of experience working with children with clefts and their families. The first clinic visit usually happens in the first year, but not necessarily before surgery. For the first few years children are seen annually, but after that it may be every two or three years depending on the child and his/her needs. Certainly the family may always request an appointment.
Why do I need to have my child’s hearing tested?
Annual hearing testing is recommended to monitor children with cleft lip/palate because they are more prone to middle ear infections and problems.
Testing may happen more frequently if middle ear problems last for a long time. If a child shows a decrease in hearing or is having chronic middle ear problems, they may be referred to an ear, nose, and throat (ENT) specialist.
Will my child require speech therapy?
Because of the cleft in the roof of the mouth, children with cleft palate cannot seal off the nose when they talk. This may make the speech sound “hypernasal”. By repairing the cleft at the appropriate time many children develop normal speech.
Despite palate surgery some children are unable to effectively seal off the nose when speaking and they may require speech therapy or an additional surgical procedure. A surgery called a “pharyngeal flap” uses tissue from the back of the throat to partially close off communication between the mouth and the nose, and improve speech.