Cleft Lip and Palate Surgery Albany - Birthmark Removal Upstate New York

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Although this information, by necessity, highlights the uniqueness of cleft children, clearly on the whole it is important to keep in mind that children with clefts are, for the most part, no different than other children. One can expect all the normal joys and challenges that are associated with parenting. Children with isolated clefts are generally of normal intelligence and go on to develop normal interpersonal relationships. Nevertheless, there are many challenges that the parents of a child with a cleft and the health care providers will face.

What is a cleft?

A cleft is simply a gap, or a space in the lip and/or palate where there should normally be tissue. Early in the embryonic period, the tissue did not come together in the region of the cleft, leaving this space. Sometimes these clefts are detected on ultrasound in utero - at other times the cleft is not apparent until birth. Not all clefts are the same. The pattern of clefting can be quite variable. The most common pattern is for both the lip and palate to be involved, but there can also be isolated clefts of the lip or palate.

What causes a cleft?

There are many different causes for clefts. However, the majority of clefts elude a direct cause and effect relationship, and it is most likely related to a combination of genetic inheritance and environmental factors. It is generally not something that the parents have any control over. The likelihood of having additional children with clefts is slightly higher than in the general population if a cleft is present in an immediate family member. A geneticist or genetics counselor can help you determine if there is a known cause for the clefting and help you determine what the chances are of having additional children with cleft.

What Challenges Will Be Faced?

Feeding
The earliest of these is likely to be feeding problems. Cleft in the lip may prevent the lips from coming together and pursing for latching on or nippling. A cleft of the palate may prevent the baby from generating negative pressure in the mouth to create suction to deliver milk into the mouth. Breastfeeding may be difficult or impossible for a child with a cleft; however, the breast milk can be pumped and delivered with a special feeder. Numerous bottles have been developed to assist in the feeding of a child with a cleft. Different styles of bottles work better for different individuals, but they all have as a goal the increase in milk flow to the baby's mouth.

The timing of surgical interventions
The first 12 to 18 months are a very busy period; afterwards the frequency of surgical interventions slows considerably. Initial repair of the lip and/or palate is usually completed by about 18 months of age. The time of surgical intervention is determined by a host of interrelated factors. The type and severity of the cleft will determine the number of procedures necessary during that period.

Cleft Lip Surgery
The lip is usually the first structure to be repaired and takes place at around three months of age. This allows time for maturation bonding and establishing good feeding patterns prior to a surgical intervention. In the interim, between birth and surgery, a variety of things may happen. Your child may be fitted with an intra-oral appliance, much like a retainer, designed to help move the palatal elements into better alignment. You will also be instructed to tape across the cleft - not to hide the cleft - but actually assist the process of tissue realignment.

Cleft Palate Surgery
Surgery on the palate is undertaken from 6 months to 18 months, based on the preference of the surgeon. The timing of palate repair is influenced by several factors, including speech development and the effect that surgery may have on future facial growth. There are several anatomic features to the palate. Most simplistically, it is divided into the hard and soft palates. The preference of our group is to delay palatal repair until 8 -12 months and repair both the hard and soft palate at the same time. The details of these procedures can be discussed with your surgeon.

Surgery on the ears
Because children with a cleft palate also have an increased incidence of fluid in the middle ear and infections, it may be recommended that tubes be placed in the eardrums during one of the cleft repair procedures. In children with cleft palates, speech may also be a problem and speech therapy may be initiated quite early.

Speech
Even when palate surgery is successful in closing the cleft, the shortness or lack of movement in the palate may result in abnormally nasal sounding speech. Other operations are designed to correct this type of problem if it develops.

Nasal reconstruction
The abnormal appearance of the nose associated with a cleft lip usually improves significantly when the lip is repaired. However, further nasal surgery is typically required to improve the symmetry and appearance of the nose. The timing of nasal procedures is related to the severity of the deformity and the surgeon's preference relative to the overall cleft care plan.

Dental rehabilitation
The majority of cleft patients require extensive orthodontics in conjunction with surgical intervention. If the cleft passes through the gum line, a bone graft may be required to provide adequate bone stock for proper alignment and expansion of the palate of the adult teeth by an orthodontist. This is usually done later in the course of cleft care around the age of 7-9.

Long-term follow up
As the potential for cleft-related problems does not end with the successful repair of the clefts, it is critical to continue long term follow up with your cleft care provider so that any problems developing with hearing, speech, dental occlusion, facial growth or appearance can be caught early and dealt with appropriately. Because of issues with facial growth, some definitive corrective procedures for the nose and facial bones are best deferred to the teen years.

If you want to learn more about what The Center for Facial Plastic Surgery and Laser Skin Care of North Eastern New York can offer you, please take a look at our website and contact our Albany cleft palate surgeon today to schedule a consultation.