The goals of treatment for cleft lip and cleft palate are to ensure the child's ability to eat, speak, hear and breathe and to achieve a normal facial appearance. Treatment involves surgery to repair the defect and therapies to improve any related conditions.
Surgery to correct cleft lip and palate is based on your child's particular situation. Following the initial cleft repair, your doctor may recommend follow-up surgeries to improve speech or improve the appearance of the lip and nose. Surgeries typically are performed in this order:
- Cleft lip repair — between 1 and 4 months of age
- Cleft palate repair — between 5 and 15 months of age
- Follow-up surgeries — between age 2 and late teen years
Cleft lip and palate surgery takes place in a hospital. Your child will receive an anesthetic, so he or she won't feel pain or be awake during surgery. Many different surgical techniques and procedures are used to repair cleft lip and palate, reconstruct the affected areas, and prevent or treat related complications. In general, procedures may include:
- Cleft lip repair. To close the separation in the lip, the surgeon makes incisions on both sides of the cleft and creates flaps of tissue. The flaps are then stitched together. The repair should create a more normal lip appearance, structure and function.
- Cleft palate repair. Various procedures may be used to close the separation and rebuild the hard and soft palate (roof of the mouth), depending on your child's particular situation. The surgeon makes incisions on both sides of the cleft and repositions the tissue and muscles. The repair is then stitched closed.
- Ear tube surgery. For children with cleft palate, ear tubes also may be placed during the first surgery to reduce the risk of frequent ear infections, which can lead to hearing loss. Ear tube surgery involves placing tiny cylinders in the eardrum to prevent fluid buildup.
- Surgery to improve cosmetic appearance. Additional surgeries may be needed to improve the appearance of the mouth, lip and nose.
Surgery can result in significant improvement in your child's appearance, quality of life, and ability to eat, breathe and talk. Possible risks of surgery include bleeding, infection, poor healing, puckering of scars, and temporary or permanent damage to nerves, blood vessels or other structures.
Treatment for complications of cleft lip and cleft palate
Your doctor may recommend additional treatment for complications caused by cleft lip and cleft palate. Additional treatments may include:
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- Hearing aids or other assistive devices for a child with hearing loss
- Speech therapy to correct difficulty with speaking
- Therapy with a psychologist to help a child cope with the stress of repeated medical procedures
- Flint PW, et al. Cummings Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, Pa.: Mosby Elsevier; 2010. http://www.mdconsult.com/books/about.do?about=true&eid=4-u1.0-B978-0-323-05283-2..X0001-8--TOP&isbn=978-0-323-05283-2&uniqId=230100505-57. Accessed May 24, 2012.
- Kliegman RM, et al. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa.: Saunders Elsevier; 2011. http://www.mdconsult.com/das/book/body/208746819-6/0/1608/0.html. Accessed May 24, 2012.
- Submucous clefts. Cleft Palate Foundation. http://www.cleftline.org/what-we-do/publications/fact-sheets/submucous-clefts/. Accessed May 25, 2012.
- Dixon MJ, et al. Cleft lip and palate: Understanding genetic and environmental influences. Nature Reviews Genetics. 2011;12:167.
- Wilkins-Haug L. Etiology, prenatal diagnosis, obstetrical management and recurrence of orofacial clefts. http://www.uptodate.com/index. Accessed May 29, 2012.
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