Cleft Palate and Cleft Lip (cont.)
John Mersch, MD, FAAP
Dr. Mersch received his Bachelor of Arts degree from the University of California, San Diego, and prior to entering the University Of Southern California School Of Medicine, was a graduate student (attaining PhD candidate status) in Experimental Pathology at USC. He attended internship and residency at Children's Hospital Los Angeles.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
- Cleft lip and cleft palate facts
- What is a cleft lip? What is a cleft palate?
- How often do these birth effects occur?
- What are the causes and risk factors for developing a cleft lip and cleft palate?
- How do physicians diagnose a cleft lip and cleft palate?
- What are complications of a cleft lip and cleft palate?
- What is the treatment for a cleft lip and cleft palate?
- What is the prognosis for a cleft lip and cleft palate?
- Is it possible to prevent a cleft lip or cleft palate?
- Find a local Plastic Surgeon in your town
What is the treatment for a cleft lip and cleft palate?
Successfully treating an infant or child with cleft lip and/or palate requires patience by both the parents and ultimately the patient. Several years of multiple surgical procedures are generally necessary to provide a satisfactory outcome. The repair of a cleft lip is usually addressed at approximately 3 months of age. One or two surgical procedures may be necessary to achieve both effective lip function and cosmetic repair. Cleft palate repair is a multistep series of surgical procedures starting at about 6 to 12 months of age and finalized in the later teen years. The first procedure is typically repair of the defect in the palate, which allows better feeding and weight gain and reduces the frequency of hearing loss and recurrent ear infections. Repair of the palate defect also encourages appropriate development of the upper jaw (maxilla) and other facial bones. At approximately 8 years of age, a bone graft is performed to further support the upper jaw structure and aid in speech articulation. Braces are generally required to straighten permanent teeth and plastic surgical scar revision (removal) is done after the majority of adolescent growth has occurred.
What is the prognosis for a cleft lip and cleft palate?
While the effective treatment for cleft lip and cleft palate requires many surgical procedures, speech therapy, and consultation with many medical specialists, it should be anticipated that an excellent outcome regarding appearance and function can be achieved. In order to maximize the medical management as well as coordination with multiple health-care professionals and parents, a cleft palate team is generally the preferred approach to coordination of care. Such teams are commonly found at pediatric teaching hospitals in major cities. The members of the medical team will commonly consist of
- plastic surgeon,
- otolaryngologist (ear, nose and throat doctor [ENT]),
- oral surgeon,
- prosthodontist (makes dental appliances),
- dentist and orthodontist,
- speech pathologist/therapist,
- audiologist (hearing specialist),
- social worker/psychologist,
- nurse coordinator.
Is it possible to prevent a cleft lip or cleft palate?
The large majority of infants experiencing cleft lip or cleft palate do not have a genetic predisposition or obvious risk factors. During pregnancy, there are issues that may increase the likelihood of producing a newborn with cleft lip and/or cleft palate. These may include the following:
- Certain medications to help prevent maternal seizures or migraine headaches (for example, topiramate [Topamax])
- Certain medications that are used as cancer chemotherapy (including methotrexate [Rheumatrex, Trexall])
- Smoking cigarettes (no information yet regarding e-cigarettes)
- Alcohol consumption
- Lack of folic acid supplementation prior to conception and throughout the pregnancy
Medically reviewed by Margaret Walsh, MD; American Board of Pediatrics
Cleft Palate Foundation. <http://www.cleftline.org/parents-individuals/publications/support>
Jones, Kenneth Lyon. Smith's Recognizable Patterns of Human Malformation, 5th ed. Philadelphia, Pa.: WB Saunders Co., 1997.
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