Cleft Lip and Palate Team

The Cleft Lip and Palate Team is an interdisciplinary team that serves the state of West Virginia as well as surrounding areas where care for this patient population does not exist.

Benefits of the Team Approach

The multidisciplinary team allows children to benefit from the consolidated knowledge of many specialists from different fields in one place and in one visit.

Cleft lip and palate is correctable. Surgery and proper care normally result in improved appearance and healthier, happier lives for children. Equally as important is ongoing care for related problems that may affect communication skills and self-image. A number of specialists for speech, hearing, and dental problems, as well as social and emotional concerns, are essential for close monitoring throughout childhood. Close communication with the primary pediatrician or family doctor is essential.

The purpose of this team approach is to coordinate the best medical care for our patients and to ensure that their families are involved as an active partner in the treatment process.

This program includes:

  • Neonatology
  • Otolaryngology
  • Plastic Surgery
  • Oral and Maxillofacial Surgery
  • Dentistry
  • Orthodontics
  • Speech Language Pathology
  • Developmental Pediatrics
  • Audiology
  • General Pediatrics
  • Genetics
  • Social Work

What are cleft lip and cleft palate in children?

Cleft lip and palate are openings or splits in the upper lip or roof of the mouth (palate). A child can be born with a cleft lip, cleft palate, or both. Cleft lip and palate may be the only birth defects, or they may happen with other defects.

A cleft lip may be as mild as a notch of the lip. Or it may be as severe as a large opening from the lip to the nose.

A cleft palate may leave an opening that goes into the nasal cavity. Cleft palate is not as noticeable as cleft lip because it is inside the mouth. The cleft may:

  • Involve one or both sides of the palate
  • Go from the front of the mouth or hard palate to the throat or soft palate
  • Include the lip

What causes cleft lip and palate in a child?

Cleft lip and palate happen when a baby develops in the womb. Researchers don’t know the exact cause of cleft lip and palate. It can be caused by genes passed on from parents, as well as environmental factors. Environmental factors include taking certain medicines during pregnancy, smoking or drinking alcohol during pregnancy, infections, and too little vitamin B and folic acid during pregnancy. Parents who have cleft lip, cleft palate, or both, or who have other kids with the problem are at an increased risk of having babies with the defect. A cleft lip and palate can be seen during the first exam by your baby’s healthcare provider.

What are the symptoms of cleft lip and cleft palate in a child?

The symptoms of these problems can be seen during the first exam by your baby’s healthcare provider. How much the lip or palate differs from normal can vary. The symptoms can include:

  • Lip does not close completely
  • Roof of the mouth does not close completely
  • Neither the lip nor the roof of the mouth closes completely

What are the complications of cleft lip and palate in a child?

Beyond the appearance of a cleft lip, other possible complications include:

  • Feeding trouble. Feeding trouble happens more with cleft palate defects. Your baby may not be able to suck properly because the roof of the mouth is not formed completely.
  • Ear infections and hearing loss. Ear infections are often caused by problems with the tubes that connect the middle ear to the throat (eustachian tubes). Infections that come back again and again can then lead to hearing loss.
  • Speech and language delay. Muscles involved with speech may not work well. This can lead to a delay in speech or odd speech. Talk with your child’s healthcare provider about seeing a speech therapist.
  • Dental problems. The child may have problems with his or her teeth. Your child may need to see an orthodontist. This is a dentist with special training to treat teeth that are out of line and problems with the jaw.

 

Overview of Treatment Plan for Children with Cleft Lip/Palate

Procedures

0-2 years: Patients with cleft lip usually have repair after nasoalveolar molding is complete between three and six months of age. Those with a palate cleft usually have repair prior to onset of speech between 9 and 18 months of age. Secondary surgery for refinement can be done at any time to improve the appearance of the child.

3-4 years: A few patients may need minor surgery to improve the alignment of the lip lines. The shape of the nose can also be improved.

4-6 years: Any child having speech problems in spite of palate repair and speech therapy may need a second surgery to improve the speech and reduce the nasality.

6-9 years: All cases involving clefts through the alveolar ridge of the maxilla require surgical placement of cancellous (spongy) bone. This bone is usually harvested from the hip.

14-16 years: Many children born with cleft lip and/or cleft palate or other craniofacial anomalies are either born with significant imbalance of their jaw alignment or jaw alignment imbalance occurs during their maturation due to poor growth of upper jaw. Normal jaw relationship is essential for good appearance, normal chewing process, and speech. Any misalignment of jaws will need orthodontic treatment followed by surgeries on both the jaws (orthognathic surgery). This often requires long pre-operative orthodontic treatment and removal of certain teeth. The orthodontic treatment may continue following surgery, and a prosthodontist may help to replace missing teeth.

16-20 years: Depending on the desire of the patient, final rhinoplasty (nose surgery) to improve the shape of nose can be done.

Check out educational materials from the American Cleft Palate-Craniofacial Association: cleftline.org/who-we-are/what-we-do/publications.