Has your child been diagnosed with cleft lip or palate? Here are 4 important things to know
Cleft lip and cleft palate are among the most common congenital facial anomalies, affecting approximately 1 in every 700 births worldwide. They can influence the appearance of your child’s face and also impact eating, speaking, and breathing abilities. The overall prognosis for children with cleft conditions is excellent, and treatment can help them lead healthy, fulfilling lives. However, learning that your child has been diagnosed with a cleft lip or palate can be overwhelming, and you likely have questions and concerns about what lies ahead for your little one.
As a specialist in pediatric reconstructive procedures, I am here to help support you and your child as you navigate these conditions. Here are 4 things you need to know about a cleft lip or cleft palate diagnosis.
1. Cleft lip and cleft palate are two different conditions
A cleft lip is a physical split or separation of the two sides of the upper lip, which creates a narrow opening or gap. A cleft palate occurs when there is a hole in the roof of the mouth, sometimes opening into the nose. These conditions are caused by a combination of genetic and environmental factors, resulting in an incomplete fusion of bones and tissues during early fetal development.
A child may experience both conditions simultaneously and the severity of either varies from mild to severe.
2. You’ll have a multidisciplinary care team
The complexity of treating a cleft lip or cleft palate is best achieved with a collaborative approach to care. The care team works together to address the comprehensive needs of your child to ensure the success of the surgeries and support speech development, hearing function, and dental health before and after surgery is complete.
Here’s how each specialist contributes to the care team:
Pediatric craniofacial plastic surgeon: Plan and perform the necessary surgeries to repair the physical defect, improve facial aesthetics, and facilitate normal development of speech and eating abilities.
Pediatric dentist: Perform regular dental check-ups to address cavities or dental problems to maintain oral hygiene and monitor teeth and gum development.
Orthodontist: Monitor jaw growth and implement interventions (like braces) to ensure proper teeth alignment, which can be affected by the cleft condition and previous surgeries.
Otolaryngologists (ENT Specialists): Assess and treat hearing problems, manage ear infections, and assist with breathing and speech difficulties resulting from the cleft.
Speech-language pathologists: Evaluate and treat speech and language disorders resulting from cleft lip and/or palate. They work closely with your child to improve articulation, language development, and communication skills before and after surgery as needed.
Audiologists: Conduct hearing tests and assessments to identify any hearing loss or auditory issues and provide interventions such as hearing aids when needed.
This multidisciplinary approach is important to achieve the best possible outcomes for your child’s appearance, speech, and overall development.
Dr. Aboutanos and her team are accredited and approved by the ACPA (American Cleft Palate Craniofacial Association).
3. The treatment options
Richmond cleft lip and cleft palate surgery begins with a comprehensive treatment plan specifically tailored to your child’s needs and anatomy.
Cleft lip repair (cheiloplasty)
Timing: Cheiloplasty typically occurs within the first 3-6 months of life.
Procedure: Incisions are made on either side of the cleft to create flaps of tissue that are then drawn together and stitched to close the gap. This repair improves the appearance of the lip and enables better function for eating and speaking. The goal is to achieve a more natural lip shape and to minimize the appearance of the scar.
Recovery: Recovery time will vary, but initial healing typically occurs within about 3 weeks, with continued improvements over several months. Pain management and careful feeding are important during the first few weeks after surgery.
Cleft palate repair (palatoplasty)
Timing: Palatoplasty is recommended between 6 - 12 months and no later than 18 months to optimize speech development.
Procedure: The muscles and tissues of the soft palate are rearranged and reattached to close the gap in the roof of the mouth and create a continuous, functional palate. Sometimes, a piece of tissue is taken from another area, such as the back of the mouth, to lengthen the palate if velopharyngeal insufficiency is present.
Recovery: Healing takes about 1-2 weeks and improvements in oral function will continue over several months, with close monitoring by the care team. You’ll need to follow special feeding instructions and take precautions to prevent injury to the surgery site.
While the prospect of your child undergoing surgery can be daunting, these procedures have high success rates and are often life-changing. After surgery, your child will receive adjunct treatments based on their unique case from one or more of the specialists mentioned above.
4. Revision surgery may be necessary down the road
As facial structures continue to develop and change, these natural growth processes can affect the initial outcomes of cleft surgeries, potentially requiring further interventions to refine or maintain the results. Here are some reasons revision surgery may be recommended:
Speech concerns: If speech problems persist or new issues develop due to palate structure changes, a revision surgery and additional speech therapy may be considered.
Aesthetic refinements: As the face grows, revision surgery can correct asymmetries or irregularities in the appearance of the lip, nose, or palate that were not apparent or concerning in earlier childhood but became more pronounced with maturity.
Once facial growth is complete, we can make subtle cosmetic revisions to the nose and lip to further improve their appearance into adulthood.
Find expertise and support in cleft conditions
Dr. Sharline Aboutanos is a board-certified female plastic surgeon Richmond families turn to for expert, compassionate care. Dr. Aboutanos is fellowship-trained in craniofacial and pediatric plastic surgery and is a Fellow of the American Academy of Pediatrics. She is also the Medical Director of the accredited Cleft and Craniofacial Team at St. Mary’s Hospital in Richmond.
To learn more about how we can support your child’s journey toward healing and growth, schedule a consultation with Dr. Aboutanos by calling (804) 355-3410 or contact her online.