Cleft Lip & Palate

Are Cleft Palates Common?

Cleft lip and palate is the most common facial deformity, occurring in 1 out of every 700 live births. Our region is particularly vulnerable due to a couple of prevalent factors: nutritional deficiencies and large Latino and Native American populations, which are statistically more vulnerable to cleft lip and palate deformities.

What Causes Cleft Palates in Newborns?

The etiology of cleft lip and palate is multifactorial and has been linked to genetic factors, teratogenic drugs, nutritional deficiencies, amniotic banding, chemical exposures, maternal hypoxia, and radiation. Most clefts in families are sporadic, but if one parent has a cleft, there is a 4-6% chance that their baby will also have a cleft. Interestingly, boys are twice as likely to have a cleft lip (with or without palatal involvement), while girls are more likely to have an isolated cleft palate.

Are Cleft Palates Syndromic?

If an isolated cleft palate is present, there is approximately a 50% chance that the baby will have an associated syndrome. This contrasts with a cleft lip patient (with or without palatal involvement), which is only likely to have an associated syndrome in approximately 10% of cases. In patients with an isolated cleft palate, a thorough work-up should be performed if the patient is not progressing as expected.

What Are Signs of a Cleft Palate?

Cleft care is complicated, and these children may often have limited exposure to an ACPA-approved Cleft and Craniofacial Team. It is essential that they be plugged into a Cleft or Craniofacial Team. Common problems children with cleft lip and palates may experience include:

  • Speech issues and difficulties in school (psychosocial or hearing-related).
  • Growing hair long to cover their face.
  • Dental issues such as dental disease.
  • Sleep apnea.
  • Social isolation or challenges thriving in a school environment.
  • Obvious deformity.
  • Liquids or food coming out of their nose when eating.

How Soon Should a Child Be Seen for a Cleft Palate?

It is crucial that these children be involved in an ACPA-approved Cleft and Craniofacial Team. The team comprises individuals who have dedicated their practices specifically to cleft and/or craniofacial care. The team includes cleft and craniofacial surgeons, ear, nose, and throat surgeons, oral and maxillofacial surgeons, neurosurgeons, craniofacial orthodontists, pediatric dentists specializing in cleft/craniofacial deformities, speech and language pathologists, occupational therapists, nutritionists/dietitians, nursing coordinators, and social workers.

When Should Primary Cleft Lip Deformity be Repaired?

The primary cleft lip deformity may be complete or incomplete and is best repaired between 3-6 months of age. For complete clefts, nasoalveolar molding (NAM) is helpful in decreasing the size of the cleft defect before surgery. Working with NAM providers helps get cleft babies ready for surgery.

How is a Primary Cleft Palate Deformity Surgery Performed?

The palate is essential for appropriate speech and feeding. Palatal repair should be performed between 10-18 months of age to ensure proper speech development. Different types of palatal repairs exist, but the preferred technique is the Furlow palatoplasty, which increases length and aids in speech.

When Should a Cleft Alveolus (Cleft Bone Graft) Surgery be Done?

The alveolar cleft bone graft surgery is usually performed between the ages of 6-12, depending on expected tooth eruption. After cleft lip and palate repairs, a small fistula (hole) may remain in the area between the nose and mouth. Bone grafting is now done using cadaver bone and bone morphogenetic protein (rhBMP), which acts as a scaffold and encourages the body’s own stem cells to produce bone.

What is Cleft Lip Revision?

As the repaired lip grows, slight widening or unfavorable healing may occur, leading to the need for minor cosmetic touch-ups on the lip. This procedure is typically done between the ages of 5-10, but can be performed in adulthood if needed.

What is Cleft Orthognathic (Jaw) Surgery?

Approximately 50% of children with cleft lip and palate experience slower growth of the upper jaw compared to the lower jaw. This results in a sunken middle face and an underbite. Jaw surgery can be life-changing for these children, and planning involves medical modeling (computer-generated models) that accurately represent the child’s occlusion and bone structure. Typically, the surgery is performed once skeletal growth is nearly complete (in late teens).

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