Houston Plastic and Craniofacial Surgery
1-713-791-0700
What is the Treatment for Cleft Lip/Cleft Palate? Cleft lip and palate are oral or facial malformations that happen in the early stages of pregnancy, when the fetus is developing. The sides of the baby’s lip and the roof of the mouth do not fuse together as they should, which result in openings or splits in the upper lip, the roof of the mouth or both. According to the CDC (Centers for Disease Control and Prevention), about 2,650 babies are born with a cleft palate and 4,440 babies are born with a cleft lip with or without a cleft palate every year in the U.S. Treatment Treatment begins as early as possible and the first impressions or molds are taken within days after birth. Presurgical jaw orthopedic therapy usually starts after the baby is three weeks old. For this, plastic surgeons use the nasoalveolar molding (NAM) technique, which lessens the severity of the initial cleft and nasal deformity. This technique is used to construct the columella (middle part of the nose) non-surgically using the method of tissue expansion. The surgeon adds a nasal portion to the molding
Houston Plastic and Craniofacial Surgery
1-713-791-0700
plate to correct the nasal tip, the base on the affected side, and the position of the philtrum (the vertical groove in the middle area of the upper lip) and the columella. The second impression is taken at about four months of age and the third is taken just before the deciduous incisors appear. Another impression is taken when all the deciduous teeth appear. Repair is carried out in various stages. • Cleft lip repair: This is done when the baby is between 1 and 4 months of age with the aim to make the lip appear more and to improve structure and function. The existing muscle and tissues of the child’s lip and nose are used to close the cleft. This may require one or two operations depending on the type of cleft lip. Some babies may need orthodontic treatment to guide the growth of the mouth in the right direction. A plastic plate of the child’s mouth, lip and nostrils is created according to the impression taken of the child’s gums. At 6 to 12 weeks of age the pediatric orthodontist inserts the appliance in the child’s mouth, a procedure done under general anesthesia. The plate is kept in the mouth for 6 to 8 weeks. Each week, the plate is adjusted to bring the gums closer together and to improve the repair of the lip. The plate is removed just before surgery to close the cleft lip.
Houston Plastic and Craniofacial Surgery
1-713-791-0700
• Cleft palate repair is carried out between 5 and 15 months of age. Using various procedures, the surgeon closes the cleft and rebuilds the roof of the mouth. The tissues and muscles are repositioned. • Follow-up surgeries are between age 2 and late teen years. This may involve the placing of ear tubes to reduce risk of ear infections which can affect hearing as well as procedures to improve facial appearance. Right Choice of Plastic Surgeon Critical for Success Children with cleft lip and palate may require 5-7 surgeries for correction of the condition. NAM reduces the number of surgeries required and reduces the facial scarring, trauma, inconvenience and cost involved in additional surgeries. The use of this technique requires proper training, experience and clinical skills. So choosing the right plastic surgeon is critical to the success of cleft lip/cleft palate treatment.