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Cleft lip and palate

Cleft lip and palate

Cleft lip and palate

Facial clefts occur in nearly one out of 600 births in the United States and are the most common birth defects treated by pediatric plastic surgeons. Clefts of the lip and palate are complex conditions, which affect not only the child’s appearance and self-esteem, but also a child’s ability to breathe, speak, hear and eat properly. Because of this, treatment involves the close cooperation of a number of medical and dental specialists.

Collaborative approach to care

Our team emphasizes family-centered care. Patients and families are treated as members of the team and are invited to be active participants in decision making and treatment planning. Issues related to self-esteem, hearing, speech, learning and appearance are treated in the context of the cleft/craniofacial team at Shriners Hospitals for Children — Chicago. Our goal is to foster and maximize the social, physical and psychological development of our patients.

The child’s appointment with the cleft/craniofacial team lasts all day with approximately 12 professional contacts provided during that time for your child. Families should be prepared to spend the entire day with us for the team appointment. After each team appointment, there will be a multidisciplinary team report that will be generated and reviewed by the other health care professionals treating your child.

Specialists involved

No two facial clefts are ever the same. Each child will be evaluated by a team of professionals who will coordinate the child’s treatment. Depending on the type and severity of the problem, a child may need the help of a variety of specialists, including:

  • Audiologists
  • Geneticists
  • Nurses and nurse practitioners
  • Orthodontists
  • Ear, nose and throat surgeons
  • Pediatricians
  • Pediatric dentists
  • Pediatric plastic surgeons
  • Prosthodontists
  • Psychologists
  • Speech-language pathologists
  • Social worker care managers
  • RN care managers
Information on the new cleft palate speech therapy app

The medical team

Mary O’Gara, MA, CCC-SLP, Cleft/Craniofacial Team Administrator 773-385-5405
Pravin Patel, M.D., Chief of Plastic Surgery
Julia F. Corcoran, M.D., Plastic Surgery
Mitchell Grasseschi, M.D., Plastic Surgery
David Morris, M.D., Plastic Surgery
Lee Alkureishi, M.D., Plastic Surgery
Clark Schierle, M.D. Ph.D., Plastic Surgery
Arthur Curtis, M.D., Otolaryngology
Gregory Dumanian, M.D., Plastic Surgery
Robert L. Walton, M.D., Plastic Surgery
Patty Engebretson MSN, APN, CPNP
Marisa Foss, CNP, 773-385-5597, Cleft/Craniofacial Nurse Practitioner

Infancy

The plastic surgeon repairs the cleft lip shortly after birth, usually at two to three months of age. They repair the cleft palate by 12 months of age prior to the child’s first spoken words. Many children with clefts develop hearing problems as a result of chronic ear infections. If left untreated it will create speech and language problems. The audiologists and otolaryngologists assess the child’s ears. At the time of the cleft repairs, tubes may be placed in the child’s ears to help treat the infections and maximize hearing sensitivity. In addition, many infant children may also have their gum repaired with a bone graft, depending on the circumstances, sometime after the lip repair and before the repair of the cleft palate.

Childhood

Each child’s speech development is routinely assessed by the speech and language pathologist. If treatment is needed, the speech pathologist works with the parent, the child and a local speech pathologist. Sometimes, additional surgery is needed when speech therapy alone does not improve the child’s ability to speak normally.

Surgery involves improving the function of the palate and pharynx (throat) where the air needed for sound is directed. Before the child begins school, any significant residual cleft deformities involving the lip and nose are surgically corrected to help minimize the psychological effects of the cleft deformity. Pediatric dental and orthodontic services begin to play a more important role with the development of teeth during the later years of childhood. Surgery to restore the residual cleft in the dental arch is frequently done at this age.

Adolescence

While nearly all cleft children will need braces (orthodontia), a smaller number of children will need orthognatic (jaw) surgery. In these children, the growth of the upper jaw remains behind the lower jaw and the face develops a sunken appearance as the child grows into adolescence. The surgery involves repositioning the jaws to improve the child’s bite and appearance. The plastic surgeon carefully plans the surgery with the dental specialists (dentist, orthodontist and prosthodontist) to achieve the best results. Once the facial bones are in correct relationship to each other, the final nose and lip surgery are completed.

Considerations

  • No single surgery can correct all of your child’s medical conditions.
  • Surgical reconstruction of the lip, nose, gum and palate must be timed with the child’s development.
  • The need for further correction is dependent upon how your child’s face develops. Over time, more surgeries may be needed to modify the changes that occur with growth.
  • How a scar heals depends on a number of factors:
    • Severity of the facial cleft
    • Type of surgery involved with the repair
    • Care provided after the surgery
    • Ability to heal
  • Perfect symmetry is not possible to obtain and it is important to remember that no individual has exact mirror image symmetry.
  • Children will need dental and orthodontic care, as well as speech therapy. Each of the specialties play an more important role during different periods of the child’s growth.
  • Children with clefts will need to be followed from infancy to adolescence.

Team appointments

The cleft/craniofacial team at Shriners Hospitals for Children — Chicago schedules children to be seen by most team specialists in a single day. Although this can be a long day, families have the benefit of coordinated care and our specialists are able to develop a treatment plan while the family is present. After each team appointment, a multidisciplinary team report will be generated that will be available for review by parents and other health care professionals involved with the child’s care in the home community.

   
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