In the early weeks of development, long before a child is born, the right and left sides of the lip and the roof of the mouth normally grow together. Occasionally, however, in about one of every 800 babies, those sections don't quite meet. A child born with a separation in the upper lip is said to have a cleft lip. A similar birth defect in the roof of the mouth, or palate, is called a cleft palate. Since the lip and the palate develop separately, it is possible for a child to have a cleft lip, a cleft palate, or variations of both.

If your child was born with either or both of these conditions, reconstructive plastic surgery can restore normal appearance and help your child lead a normal, healthy, happy life.

THE IMPORTANCE OF A TEAM APPROACH

Children born with a cleft lip or palate may need the skills of several medical professionals to correct the problems associated with the cleft. In addition to needing plastic surgery to repair the opening, these children may have problems with their feeding and their teeth, their hearing, their speech, and their psychological development as they grow up. Ideally this requires a team approach in management of cleft problems. Typically, a Cleft Team might include a plastic surgeon, a pediatrician, a dentist, a speech and language specialist, a social worker, a hearing specialist, an ear-nose-throat specialist, a psychologist, a nurse, and a genetic counselor.

ALL SURGERY CARRIES SOME  RISK

When surgery is done by a qualified plastic surgeon with experience in repairing cleft lip or palate, the results can be quite positive with minimum risks.

In cleft lip surgery, the most common problem is asymmetry, when one side of the mouth and nose does not match the other side. The goal of cleft lip surgery is to close the separation in the first operation. Occasionally, a second operation may be needed.

In cleft palate surgery, the goal is to close the opening in the roof of the mouth so the child can eat and learn to speak properly. Occasionally, poor healing in the palate or poor speech may require a second operation.

CLEFT LIP SURGERY

A cleft lip can range in severity from a slight notch in the red part of the upper lip to a complete separation of the lip extending into the nose. Clefts can occur on one or both sides of the upper lip. Surgery is generally done when the child is about 10 weeks old.

To repair a cleft lip, an incision is made on either side of the cleft from the mouth into the nostril. Dark pink outer portion of the cleft is turned down, the muscle and the skin of the lip are pulled together to close the separation. Muscle function and the normal "cupid's bow" shape of the mouth are restored. The nostril deformity often associated with cleft lip may also be improved at the time of lip repair or in a later surgery.

Your child may be restless for awhile after surgery that can be relieved with medication. Elbow restraints may be necessary for a few days to prevent your baby from rubbing the stitched area.

If dressings have been used, they'll be removed within a day or two, and the stitches will either dissolve or be removed within five days. You will be advised on how to feed your child during the first 10 days after surgery.

It's normal for the surgical scar to appear to get bigger and redder for a few weeks after surgery. This will gradually fade, although the scar will never totally disappear. In many children, however, it's barely noticeable.

CLEFT PALATE SURGERY

In some children, a cleft palate may involve only a tiny portion at the back of the roof of the mouth; for others, it can mean a complete separation that extends from front to back. Just as in cleft lip, cleft palate may appear on one or both sides of the upper mouth and may also be associated with cleft lip. However, repairing a cleft palate involves more extensive surgery and is usually done when the child is nine to 12 months old, so the baby is bigger and better able to tolerate surgery.

To repair a cleft palate, an incision is made on both sides of the separation, moving tissue from each side of the cleft to the center or midline of the roof of the mouth. This rebuilds the palate, joining muscle together and providing enough length in the palate so the child can eat and learn to speak properly.

RECOVERING FROM CLEFT PALATE SURGERY

For a day or two, your child will probably feel some soreness and pain, which is easily controlled by medication. During this period, you child will not eat or drink as much as usual.  You will be advised on how to feed your child during the first two weeks after surgery to allow the palate to heal properly.

THE REPAIRED LIP OR PALATE

Children with a cleft palate are particularly prone to ear infections because the cleft can interfere with the function of the middle ear. To permit proper drainage and air circulation, the ear-nose-and-throat surgeon on the Cleft Palate Team may recommend that a small plastic ventilation tube be inserted in the eardrum. This relatively minor operation may be done later or at the time of the cleft repair. In addition, surgery may be recommended when your child is older to refine the shape and function of the lip, nose, gums, and palate.