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Cleft Lip and Cleft Palate [Read/Print full article]
Overview
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In infants born with a cleft lip, palate, or both, the developing structures of the lip and palate did not close completely. The upper lip appears split and may have an opening extending beyond the base of the nose, including the bones of the upper jaw and gums. The roof of the mouth (hard palate) and/or the soft back part (soft palate) of the mouth is open. In either case, the split and opening can occur on either side or both. The lip and palate develop separately so it is possible to have a cleft in one or both.
Cleft lip and cleft palate are common birth defects, obvious at birth. They may occur as an isolated condition or can be associated with other genetic conditions. They affect appearance and may lead to problems with eating, talking, breathing, and hearing.
There are genetic and environmental causes.
This condition can be corrected with surgery, usually done in several stages, beginning in the first year of a baby's life.
Causes and Risk Factors
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It is likely that most cases of cleft lip or cleft palate are caused by the interaction of genetic and environmental factors. However, in many babies, a cause is not determined.
Genetic factors are involved when one of the parents pass on genes that cause the cleft, either as an isolated defect or as part of a syndrome that includes this defect as one of its signs.
Environmental factors involve fetal exposure to tobacco smoke, alcohol, certain medications, illegal drugs, or viruses.
Risk factors include:
- Family history. Parents who have a family history of cleft lip or cleft palate.
- Gender. Males are twice as likely to have a cleft lip, with or without a cleft palate. Females are more likely to have a cleft palate without a cleft lip.
- Race. Higher incidence in American Indian and Asian children. Lower incidence in African Americans.
- Environmental. Being exposed in mother's early pregnancy to cigarette smoke, alcohol, or illegal drugs.
Complications
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Babies and children with this condition may experience several types of problems, including:
- Feeding problems. Babies with a cleft lip can breastfeed, while those with a cleft palate may have difficulty sucking and problems with regurgitation and gagging. We will discuss feeding options with you. There are special bottle nipples or an artificial palate (obturator) that fits in the roof of your baby's mouth.
- Ear infections. Babies with a cleft palate tend to get middle ear infections. Repeated ear infections can lead to hearing loss. Regular evaluation by an audiologist for hearing loss is recommended. Children with cleft palates usually have ear tubes placed to decrease the incidence of infections.
- Dental problems. Tooth development is affected if the cleft extends into the upper gum. Regular monitoring by a pediatric dentist is recommended.
- Speech problems. Normal speech development can be affected. A speech pathologist may evaluate your child and provide speech therapy if needed.
- Psychological and social problems. The effect on your child's appearance and the necessary medical care may create stress for your family. A social worker or psychologist can assist your family in dealing with these stresses.
Treatments
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Cleft lip and cleft palate repair is a type of plastic surgery that corrects the abnormal development of your child's lip or palate, restoring function and a more normal appearance. We will work with you and a team of specialists to determine a treatment plan for your child. These specialists may include:
- Plastic surgeon
- Pediatrician
- Pediatric dentist and/or orthodontist
- Otolaryngologist (ear, nose, and throat specialist)
- Audiologist (hearing specialist)
- Speech language specialist
- Genetic counselor
- Social worker
The goal of the surgery is to close the cleft and ensure normal function (the ability to eat, speak, hear, and breathe) and growth. It is important to realize that additional surgery may be required as your child grows older.
We will work with you to determine the best time for all needed surgeries based on your child's condition. Surgeries are usually done in the following order:
- Cleft lip repair when your child is at least 10 weeks old
- Cleft palate repair when your child is 9 to 18 months old
- Follow-up surgeries as needed through late teen years
The risks associated with this type of surgery include:
- Anesthesia complications
- Bleeding
- Infection
- Poor healing of the incisions
- Irregular healing of scars
- Possible damage to nerves, blood vessels, or other structures
- Possible need for revision surgery
Surgery will be done in the hospital with your child under anesthesia. Your child will sleep through the procedure and not feel any pain. Procedures may include:
- Cleft lip repair. An incision on either side of the cleft. Flaps of tissue are pulled together and stitched.
- Cleft palate repair. An incision on either side of the cleft, with a flap technique used to reposition the tissue, close the cleft, and rebuild the roof of the mouth.
- Other surgeries. As needed to improve appearance, allow normal growth, and restore function.
The scars of a cleft lip repair are located in the natural lines of the face but will always be visible.
Coping and Support
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The birth of a baby with a cleft lip or cleft palate is a shock to the parents unless diagnosis by ultrasound occurred prior to birth. In either case, a period of adjustment is normal. You will need the support of family and friends, and you may want to talk with other parents who have a child with this condition. It is normal to have many questions.
Your first concern is the good health and development of your baby. We will work with you to provide individualized care and treatment designed specifically for your child's needs. Your baby will require the same love and care that all babies need. Your attitude will influence your child's feelings and the reaction of others to his or her condition.
Additional References:
- External Link to Cleft Palate Foundation
Your Child's Care with Me
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Your baby's cleft lip and/or cleft palate is identified at birth or by ultrasound prior to birth. Your pediatrician will facilitate the process of scheduling an appointment in my department. If appropriate, she or he might call me or one of my colleagues while you are in the office so we can all discuss your child's care together. If we decide you need an appointment with me after that discussion, we can often schedule it the same day or soon thereafter.
During your office visit, we will discuss your child's medical and family history and I will perform a physical exam. I will explain the findings of your child's exam and answer any questions or concerns you may have. We will discuss treatment options, including outcomes of surgery and possible risks and complications. Together we will create a treatment plan that is right for your child.
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If you need to talk with me after your child's visit or procedure, please call my office. You can also e-mail me with non-urgent issues from this web site whenever it is convenient for you.
If you have urgent concerns or issues while my office is closed, or need general medical advice you can call the Appointment and Advice line, available 24 hours per day, 7 days per week. You will be connected with a nurse who can give you immediate advice or assistance.
If your child is experiencing a serious problem or an emergency, call 911 or go to the nearest Emergency Room when the clinic is not open.
Coordinating Your Child's Care
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Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology and health education, makes getting your care for your child easier.
Another major benefit is our comprehensive electronic medical record system which allows all of the doctors and clinicians involved in your child's care to stay connected on your child's health status and collaborate with each other as appropriate.
When every member of the health care team is aware of all aspects of your child's condition, care is safer and more effective.
If you come to an office visit
- At the beginning of your child's visit, you will receive information about when he or she is due for well child visit (checkup) and immunizations. We can discuss and schedule any preventive tests that may be needed.
- At the end of your child's visit, you may receive a document called the "After Visit Summary" that will summarize the issues we discussed during the visit. You can refer to it if you forget what we discussed, or if you just want to recheck your child's height, weight or vital signs. (If your child is under age 12, you can also view these summaries online, under Past Visits.)
- To help you prepare for your visit, please see additional details under Office Visit.
If I prescribe medications
We will work together to monitor and assess how your child's medications are working and make adjustments as needed. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you and I will send the prescription electronically in advance of your arrival at the pharmacy.
If refills are needed in the future, you can:
- Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
- Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.
If lab testing or imaging is needed
For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures we will schedule an appointment with the radiology department. When the results are ready I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your child's laboratory results online, along with any comments that I have attached to explain them.
If I refer your child to another specialty colleague
If we decide together that your child's condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.
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I will recommend you review educational information and tools to help you prepare for your child's procedure or surgery. The information will often help you decide whether surgery is right for your child. If you decide your child should have a surgery or procedure, the information will provide details about how to prepare and what to expect.
If we proceed with surgery, I will have my Surgery Scheduler contact you to determine a surgery date and provide you with additional instructions regarding your child's procedure. Once your surgery is scheduled, a medical colleague of mine will contact you to conduct a pre-operative medical evaluation that will assure that you are properly prepared for your child's surgery.
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If surgery or a procedure is a treatment option
I will recommend you review educational information and tools to help you prepare for your child's procedure or surgery. The information will often help you decide whether surgery is right for your child. If you decide your child should have a surgery or procedure, the information will provide details about how to prepare and what to expect.
If we proceed with surgery, I will have my Surgery Scheduler contact you to determine a surgery date and provide you with additional instructions regarding your child's procedure. Once your surgery is scheduled, a medical colleague of mine will contact you to conduct a pre-operative medical evaluation that will assure that you are properly prepared for your child's surgery.
Convenient Resources for You
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As your specialist, I have a goal to provide high-quality care and to offer you choices that make your child's health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.
My Doctor Online is available to help you manage your child's care at any time that is most convenient for you. From my home page you can:
Manage your child's care securely
You can begin to manage your child's care online by requesting access through our Act for a Family Member feature. Once you have added your child to your account, you can:
- View and compose secure e-mail messages.
- Manage your child's prescriptions and refills.
- Schedule well visit and nonurgent appointments.
- View your child's Preventive Services to see whether you child is due for any immunizations or well visits.
Learn more about your child's condition
- Read about causes, symptoms, treatments and procedures.
- Find interactive health tools, videos, and podcasts to help you manage your child's condition.
- View programs to help you decide on or prepare for a surgery or procedure.
Help your child stay healthy
- Sign up for our online newsletters for parents, customized to your child's age.
- Locate health education classes and support groups offered at every medical center.
- Explore interactive programs, videos, and podcasts that focus on helping you keep your child healthy.
- View your child's Preventive Services to see whether he or she is due for any immunizations or a well visit (checkup).
If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.
This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.