Cleft Lip & Palate

Procedure Overview:

1. Cleft Lip Surgery:

   • Timing: Cleft lip surgery is typically performed when the baby is between 3 and 6 months old, though the exact timing may vary depending on the child’s health and development.
   • Procedure: The surgeon will make incisions around the cleft in the lip and reposition the tissues to close the gap. This surgery is designed to restore a more natural lip appearance, improve the ability to feed, and allow for proper muscle function. The surgeon may also work to correct any nasal deformities associated with the cleft.

2. Cleft Palate Surgery:

   • Timing: Cleft palate surgery is usually performed when the child is between 9 and 18 months old. The timing depends on the child’s growth and development, as well as the severity of the cleft.
   • Procedure: In this surgery, the surgeon will close the gap in the roof of the mouth. This involves repositioning the tissue and muscle of the palate, which helps to improve feeding, speech development, and prevent ear infections. The goal is to create a more normal functioning palate while minimizing scarring.

3. Additional Surgeries:

   • In some cases, additional surgeries may be needed later in childhood to further improve appearance, speech, or function. These can include procedures to:
     • Rebuild the lip or nose: Additional surgeries may be needed to correct any residual lip or nasal deformities as the child grows.
     • Speech therapy: Some children may require speech therapy after surgery to address any issues with speech development caused by the cleft.
     • Dental care: Children born with a cleft lip and palate may need dental work, orthodontic treatment, or even surgeries to ensure proper alignment of teeth as they grow.

Recovery Time:

• Cleft Lip Surgery:

  • Hospital Stay: Typically, the child will stay in the hospital for 1-3 days after surgery to monitor for complications and ensure proper healing.
  • Initial Recovery: The child may experience swelling, bruising, and mild discomfort, which can be managed with pain medication.
  • Feeding: Parents will need to follow special instructions on feeding and care immediately after surgery to avoid stressing the repaired lip.

• Cleft Palate Surgery:

  • Hospital Stay: After cleft palate surgery, the child may stay in the hospital for 2-3 days.
  • Post-Surgery Care: Swelling and discomfort are common in the first week, and parents will be advised on how to feed the child while the palate heals. This may involve a special feeding bottle or techniques to minimize pressure on the repaired area.
  • Long-Term Healing: Full recovery from cleft palate surgery may take several weeks, though the child can usually return to normal activities after about 1-2 weeks.

• Speech and Feeding Support: In the months following surgery, children may require ongoing support from speech therapists or specialists in feeding to ensure proper development. Parents will also need to monitor the child’s growth and overall healing during follow-up visits with the surgeon.

Risks:

While cleft lip and palate surgeries are generally safe and have a high success rate, there are some risks and potential complications:

1. Infection: As with any surgery, there is a risk of infection at the incision sites. This risk can be minimized by following post-operative care instructions carefully and keeping the wound clean.

2. Scarring: Although surgeons make every effort to minimize visible scarring, some scarring is inevitable. The scar from cleft lip surgery is typically well-hidden along the natural lines of the lip, but it may be visible in some cases. For cleft palate surgery, the scar is usually inside the mouth and not visible externally.

3. Speech Issues: Some children may experience speech problems even after cleft palate surgery. This can include difficulty pronouncing certain sounds or hypernasal speech. Early intervention with speech therapy can help address these issues.

4. Dental Issues: Children with clefts may have dental abnormalities, such as missing or malformed teeth, that may require orthodontic treatment or other dental care as they grow.

5. Nasal Deformities: After cleft lip and palate surgery, some children may still have nasal deformities or asymmetry. Additional surgeries may be needed to correct these issues.

6. Reopening of the Cleft: In some cases, the incision or repair may reopen during healing, requiring further surgical intervention. This is rare, but it can happen if the child experiences trauma or if healing does not occur as expected.

Conclusion:

Cleft lip and palate surgeries are essential for improving both the functional and aesthetic aspects of a child’s life. These procedures can help children feed, speak, and interact more comfortably and confidently. While the recovery period involves some initial discomfort and follow-up care, many children achieve excellent results with proper surgical intervention and rehabilitation. It’s important for parents to work closely with a multidisciplinary team, including plastic surgeons, orthodontists, speech therapists, and other specialists, to ensure the best outcomes for their child as well as a plastic surgeon trained in cleft lip and palate surgeries such as Dr Dorfman. The journey of cleft care involves multiple stages, and with early treatment and ongoing support, children with clefts can grow up leading healthy, fulfilling lives.