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.
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 for Children Medical Center. 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.
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:
The plastic surgeon repairs the cleft lip shortly after birth, usually at 2 to 3 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.
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.
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.