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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 defect 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 function; the child’s ability to breathe, speak, hear and eat properly can also be affected. Because of this, treatment involves the close cooperation of a multidisciplinary team of medical and dental specialists.

Cleft lip and palate conditions treated include:

  • Cleft lip
  • Cleft palate

Collaborative approach to cleft lip and palate care

The specialists at Shriners Hospitals for Children — Portland provide a comprehensive approach to meeting each child’s individual needs through specialized evaluation and treatment. As a team working with parents, our goal is to restore each child physically, psychologically and socially.

Every child is evaluated by a team of professionals who coordinate the child’s treatment from birth through adolescence. Our nurse clinicians, who specialize in the care of children with clefts, work closely with each patient and parent.

No two facial clefts are ever the same. Depending on the type and severity of the problem, a child may need the help of a variety of specialists including:

  • Pediatric plastic surgeons
  • Oral maxillofacial surgeons
  • Orthodontists
  • Speech-language pathologists
  • Nurses and nurse practitioners
  • RN care managers/social workers
  • Pediatricians
  • Dietitians
  • Psychologists

Stages of cleft lip and palate care

Infancy

The plastic surgeon repairs the cleft lip shortly after birth, usually between 6 and 12 months of age, depending on the health of the child and prior to the child’s first spoken words. Many children with clefts develop hearing problems as a result of chronic ear infections. This problem will require the attention of a pediatric otolaryngologist.

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, 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. 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 children with clefts will need braces (orthodontia), some 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 oral maxillofacial surgeon carefully plans the surgery with other 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 surgeries are completed.

Surgery

Surgery and hospitalization will be performed at Shriners Hospitals for Children — Portland.  We will work with your child’s pediatrician and other specialists to coordinate surgical procedures.

Cleft clinic

The child’s appointment with the cleft team, arranged with parental input, will be comprehensive and lengthy. Most patients will be seen by multiple specialists, including the plastic surgeon, oral surgeon, orthodontist, speech and language pathologist, dietitian, RN and RN care manager.

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. Additional surgeries may be needed over time 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 may need dental, orthodontic and/or speech therapy. Each of the specialties play an important role during different periods of the child’s growth. Children with clefts will need to be followed from infancy through adolescence.

The medical team

Nguyen, Tuan A., M.D.
Johnson, Jeremiah, D.D.S., M.D.
Shock, Todd M.D.
Lloyd, Clee, M.D.
Smith, James, M.D.
Baker, David, M.D.

   
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