A cleft lip and palate are serious problems for children. A cleft lip and palate occur when in early pregnancy, separate areas of the face develop individually and then join together, including the left and right sides of the roof of the mouth and lips. If some parts do not join properly, sections don’t meet and the result is a cleft. If the separation occurs in the upper lip, the child is said to have a cleft lip.
A completely formed lip is important not only for facial appearance but also for sucking and forming certain sounds made during speech. A cleft lip is a condition that creates an opening in the upper lip between the mouth and nose. It looks as though there is a split in the lip. Further, it can range from a slight notch in the colored portion of the lip to complete separation in one or both sides of the lip extending up and into the nose. A cleft on one side is called a unilateral cleft. However, if a cleft occurs on both sides, it is called a bilateral cleft.
A cleft in the gum may occur in association with a cleft lip. This may range from a small notch in the gum to a complete division of the gum into separate parts. A similar defect in the roof of the mouth is called a cleft palate.
Cleft lip surgery is usually performed when the child is about 10 years old. The goal of surgery is to close the separation, restore muscle function and provide a normal shape to the mouth. The nostril deformity may be improved as a result of the procedure or may require a subsequent surgery.
A cleft palate is initially treated with surgery safely when the child is between seven to 18 months old. This depends upon the individual child and his/her own situation. For example, if the child has other associated health problems, it is likely that the surgery will be delayed.
The major goals of surgery are to:
There are many different techniques that surgeons will use to accomplish these goals. The choice of techniques may vary between surgeons and should be discussed between the parents and the surgeon prior to surgery.
The cleft hard palate is generally repaired between the ages of 8 and 12 when the cuspid teeth begin to develop. The procedure involves the placement of bone from the hip into the bony defect and closure of the communication from the nose to the gum tissue in three layers. It also may be performed in teenagers and adults as an individual procedure or combined with corrective jaw surgery.
After the cleft palate has been fixed, children will immediately have an easier time swallowing food and liquids. However, in about one out of every five children following cleft palate repair, a portion of the repair will split, causing a new hole to form between the nose and mouth. If small, this hole may result in only an occasional minor leakage of fluids into the nose. If large, however, it can cause significant eating problems, and most importantly, can even affect how the child speaks. This hole is referred to as a "fistula" and may need further surgery to correct.