Q. What is Cleft Lip and Palate, and how is it treated?
A. By Janet K. Salomonson. M.D., board-certified plastic surgeon and Medical Director of the Cleft Palate Center at Saint John’s Health Center
A cleft lip is a separation and probable deficiency of tissue of the upper lip. It is the result of the failure of the tissues to fuse during the first trimester of pregnancy. It can occur on one side only (unilateral) or on both sides (bilateral). It may involve only a notch in the lip or extend into the nose and through the gum line (alveolar ridge). A cleft palate is a separation of the roof of the mouth. It results from the failure of the palatal shelves to fuse during the 10-12th week of pregnancy. It can occur with or without a cleft lip.
The exact cause of a cleft is still unknown. It is felt to be multi-factorial and occurs in approximately 1 in 700 births. There is a genetic component with a recurrence risk of approximately 3 – 5% with one affected family member. Prenatal folic acid supplementation can minimize but not eliminate the risk.
At the Cleft Palate Center at Saint John’s Health Center cleft care can being before the baby is born. With current advances in ultrasound, many families find out the baby they are expecting has a cleft. This is an opportunity for the parents to meet members of the Team and to feel better prepared to begin care when their baby is born.
Naso-alveolar molding has been available at Saint John’s since 1993, one of the first centers to offer this technique.. This treatment can be started in the newborn nursery or as soon as possible at the Cleft Palate Center.
Our nurse coordinator/feeding specialist is available for consultations to assure feeding issues are addressed so the baby can have a healthy start and be ready to begin surgical reconstruction.
The baby will be evaluated by a multidisciplinary team including pediatrician, nurse, surgeon, ENT surgeon, and other consultants as indicated to develop a plan of care.
Initial lip and nasal reconstruction usually occurs at approximately 10 weeks of age. The palate is usually repaired at 9 to 12 months age. There may be a need for additional reconstruction as the child grows. The exact number of procedures required depends on the initial diagnosis and changes with growth.
Current Team Care can help children born with cleft lip and palate lead healthy, happy, normal lives.