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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 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 — Springfield provide a comprehensive approach to meeting each child’s individual needs through expert evaluation and treatment. Our multispecialty team address appearance issues of lip and nose restoration, functional issues of feeding, hearing, speech development, and changes with growth, all in collaboration with the parents and child. Our registered nurse care managers coordinate communications between the team, parents, school and community agencies, emphasizing family-centered care.

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
  • Ear, nose and throat surgeons
  • Pediatric geneticists
  • Speech-language pathologists
  • Occupational therapists
  • Orthodontists
  • Nutritionists
  • Nurses and nurse practitioners
  • Registered nurse/social worker care managers
  • Pediatricians

Causes

There is no one cause for clefting, but may be multifactorial with a link to family history, medications, drugs, alcohol, lack of vitamin C, or associated syndromes.

Stages of cleft lip and palate care

Prenatal consultation

When an infant is diagnosed with a cleft lip and/or palate before birth by ultrasound, a prenatal consultation is available with our plastic surgeon and speech language pathologist/feeding expert. This meeting provides expectant parents accurate information regarding services available.

Infancy

The plastic surgeon repairs the cleft lip shortly after birth, usually at one to six months of age and repairs the cleft palate by 9 to18 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. This problem will require the attention of a pediatric otolaryngologist. At the time of cleft repairs, tubes may be placed in the child’s ears to help treat the infections and maximize hearing sensitivity.

Childhood

Each child’s speech development is routinely assessed by the team’s speech and language pathologist. If treatment is needed, the speech pathologist works with the parent, the child and a speech pathologist within the child’s community. 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 speech is developed and modified. 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 done at 9 to 12 years of age.

Cleft clinic

When a child is first seen in the cleft clinic, evaluation is done by each of the specialists before surgical or treatment intervention is begun. If the gap of the cleft is very wide, a CAD/CAM pre-surgical orthopaedics program is offered before lip repair.

On a regular basis, the child’s appointment with the cleft team can last several hours and will be arranged with parental input. Most patients will be seen by multiple specialists including the plastic surgeon, ENT surgeon, pediatric geneticist, speech and language pathologist, nutritionist, orthodontist, clinic nurse, social worker/registered nurse care managers, occupational therapist, medical photographer and a child life specialist.

The timeline for surgical intervention is timed with the child’s growth and development, and may be as follows:

2–4 months Pre-surgical orthopaedics (Latham appliance, Shriners CAD series)
3–6 months Cleft lip repair
9–18 months Cleft palate repair and PE tubes
1–16 years Speech therapy
5–7 years Pharyngeal flap
8–14 years Orthodontia
9–14 years Bone graft
14–18 years Orthognathic (mid-face advancement)
Anytime Revisions

Later subsequent surgeries may include aides to speech, repeat ear tubes, bone graft to the cleft gum, repositioning of upper jaw bones, scar revisions and nasal surgery.

The clinic meets twice a month, followed by a team conference where the specialists share their observations and recommendations.

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.

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 one of the specialties plays 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

Director of Cleft Lip and Palate Clinic
Philip B. Stoddard, M.D.

Plastic Surgeons
Kristin Stueber, M.D.
Charles Castiglione, M.D., FACS
Joyce K. McIntyre, M.D.

Pediatric Geneticist
Mary-Alice Abbott, Ph.D., M.D.

Otolaryngologist-ENT
Carl Reiner, M.D.

Orthodontists
Aaron DeMaio, D.M.D.
Stanley Alexander, D.M.D.

Pediatric Neurodevelopment
Lawrence C. Kaplan, M.D., ScM, FAAP

Nurse Clinic Coordinator
Teresa M. Lynch, RN

Nurse Care Manager
Elizabeth Starzyk, RN, BSN

Speech
Daisy Mathias, MS, CCC-SLP
Monica Newcity, MA, CCC-SLP

Occupational Therapy
Jessica Kamauff, M.Ed., OTR/L

Nutritionist
Jennifer Hall, MS, RD, LDN

Family Services
Sandra Morales, MSW, LMSW

Child Life
Samantha West, MSW, CCLS

Medical Photographer
Kent Spiry

To schedule an appointment, call new patient access at 413-735-1234 or 800-322-5905.

   
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