How are cleft lip and palate treated?

How are cleft lip and palate treated?

A cleft lip may require 1 or 2 surgeries, depending on the extent (complete or incomplete) and width (narrow or wide) of the cleft. The first surgery is usually performed by the time a baby is 3 months old.

Several techniques can improve the outcomes of cleft lip and palate repairs when used appropriately before surgery. They are non-invasive and dramatically change the shape of the baby’s lip, nose and mouth:

• A lip-taping regimen can narrow the gap in the child’s cleft lip.
• A nasal elevator is used to help form the correct shape of the baby’s nose.
• A nasal-alveolar molding (NAM) device may be used to help mold the lip tissues into a more favorable position in preparation for the lip repair.

The first surgery, to close the lip, usually occurs when the baby is between 3 and 6 months old. The second surgery, if necessary, is usually done when the child is 6 months old.

Repair of a cleft palate is performed at 12 months and creates a working palate and reduces the chances that fluid will develop in the middle ears. To prevent fluid buildup in the middle ear, children with cleft palate usually need special tubes placed in the eardrums to aid fluid drainage, and their hearing needs to be checked once a year. This is often done at the time of palate repair.

About 30-40 percent of children with a cleft palate need further surgeries to help improve their speech. Speech is usually assessed between ages 4 and 5. Often a nasopharyngeal scope is performed to check the movement of the palate and throat. A decision is then made, together with the speech pathologist, if surgery is needed to improve the speech. This surgery is usually performed around age 5.

Children with a cleft involving the gum line may also need a bone graft when they are about 6-10 years old to fill in the upper gum line so that it can support permanent teeth and stabilize the upper jaw. Once the permanent teeth grow in, a child will often need braces to straighten the teeth and a palate expander to widen the palate.

Additional surgeries may be performed to improve the appearance of the lip and nose, close openings between the mouth and nose, help breathing, and stabilize and straighten the jaw.