CLEFT LIP AND PALATE
Cleft lip and palate repair is a type of oral surgery to correct abnormal development, both to restore function and to restore a more normal appearance.
Cleft lip, an opening in the lip (cheiloschisis) and cleft palate, an opening in the roof of the mouth (palatoschisis) are two of the most common birth defects affecting children in North America. A cleft lip may be just a small notch in the edge of the lip, or it could extend into the nose and even the gum. A cleft palate can vary in size, and be on one side of the roof of the mouth (unilateral) or on both sides of the mouth (bilateral). The opening may be small or go the full length of the palate. Both are treatable with surgery within the first year or two of life.
The bones and tissues of a baby’s upper jaw, nose, and mouth normally fuse together to form the roof of the mouth and the upper lip during the first 6 to 10 weeks of pregnancy. A cleft happens when parts of the lip and mouth do not completely fuse together.
Most clefts fit into these three categories:
- Cleft Lip, by itself — most common in boys
- Cleft Palate, by itself — most common in girls
- Cleft Lip and Cleft Palate, together — more common in boys
Babies with just a cleft lip don’t usually have feeding problems. But when the palate is involved, feeding can be a big challenge, because the palate that normally prevents food and liquids from entering the nose, is open, and that causes babies to swallow a lot of air and regurgitate food into the nose. It also makes it harder for babies to latch on and suck during breastfeeding or bottle feeding. There are special nipples and bottles available to overcome this problem.
Children with a cleft lip and palate often have dental problems that may include small teeth, missing teeth, extra teeth, or teeth that are in an incorrect position. They may have a defect in the gums or the ridge of jaw bone that supports the teeth, which can prevent permanent teeth from coming in properly. A child who had a cleft palate repair may need observation by a dentist or orthodontist, to make sure the teeth do not need correcting as they come in.
Speech problems are most prevalent with cleft palate, but not so much with cleft lip. These may continue after surgical repair (about 1 in 5). Most often, this results in the child’s voice having a nasal quality, because the palate doesn’t move well enough to prevent air from leaking out of the nose. Speech therapy may be helpful.
Hearing problems are also common in children with cleft lip or cleft palate, because of the risk for fluid buildup in the middle ear that can lead to ear infections. Your child should have a hearing test early on, and it should be repeated once or twice a year.
To insure the best development possible, regular visits with a pediatric dentist who specializes in cleft lip and palate, to check a child’s mouth growth and development, identify any problems, and provide timely treatments, are important.
Most clefts can be repaired to improve your child’s ability to eat, speak, hear and breathe, and to restore a more normal appearance and function, but also to insure your child’s ability to function and grow normally, both physically and socially.
Craniofacial surgery is a subspecialty of maxillofacial and plastic and reconstructive surgery, designed to correct and reconstruct acquired or congenital (present at birth) deformities of the head, skull, face, neck, jaws, etc., or injuries to the soft tissue and bone in the head and neck (craniofacial surgeons deal with bone, skin, nerve, muscle, teeth, etc.).
Defects typically treated by craniofacial surgeons include the following:
- Craniosynostosis (isolated and syndromic),
- Rare craniofacial clefts,
- Acute and chronic consequences of facial fractures,
- Cleft lip and palate,
- Treacher Collins Syndrome,
- Apert’s Syndrome,
- Crouzon’s Syndrome,
- Craniofacial microsomia,
- other congenital ear anomalies
- and many others.
This is the premature closing of the spaces between the bones of the skull, resulting in abnormal skull growth, and is one of the most common conditions treated with craniofacial surgery. It’s called a cranial vault remodeling.
This condition occurs when one or more of the fibrous joints (called sutures) between bones in the skull of an infant prematurely fuses by turning into bone (ossification), causing the growth pattern of the skull and facial features to become deformed. The sutures allow a tiny amount of movement, allowing space for expansion to accommodate the growing brain. When there is not enough space for the growing brain, the result is increased pressure in the brain, which can lead to visual impairment, sleeping impairment, eating difficulties, or an impairment of mental development combined with a significant reduction in IQ. The expanding brain is the main stimulus for the rapid growth of the skull in the first years of life.
Craniosynostosis is called simple when one suture is involved, and complex when two or more sutures are involved. It can occur as part of a syndrome or as an isolated defect (nonsyndromic).
There are several classifications of deformities of the human skull:
- Scaphocephaly – Long narrow head, runs from the front to the back of the head
- Trigonocephaly – Pointed forehead, located in the medial line of the forehead
- Plagiocephaly – Head flattened on one side, coronal sutures (L to R top of head)
- Brachycephaly – Flat head syndrome, coronal sutures (L to R top of head)
Procedures are performed at a young age in order to provide the brain with enough space to grow and prevent further abnormal growth of the skull.
Babies sometimes develop a flattened head (plagiocephaly and brachycephaly) when they’re a few months old, usually as a result of them spending a lot of time lying on their back, which reduces the risk of sudden infant death syndrome (SIDS).
Simple measures to take pressure off the flattened part of their head can also help:
- give your baby time on their tummy during the day – encourage them to try new positions during play time, but make sure they always sleep on their back as this is safest for them
- switch your baby between a sloping chair, a sling and a flat surface – this ensures there isn’t constant pressure on one part of their head
- change the position of toys and mobiles in their cot – this will encourage your baby to turn their head on to the non-flattened side
- alternate the side you hold your baby when feeding and carrying
- reduce the time your baby spends lying on a firm flat surface, such as car seats and prams – try using a sling or front carrier when practical
These problems are quite common, affecting around one in every five babies at some point. In most cases they aren’t a major cause for concern, as they don’t have any effect on the brain and the head shape will often improve by itself over time. Your baby won’t experience any pain or other symptoms, or any problems with their general development.
If you are interested in cleft lip / palate and craniofacial surgery in Costa Rica, fill out the “Find a Dentist” form on this page. One of our patient advocates will reply to your needs.