Cleft Lip & Palate
Babies with a cleft lip or palate may be diagnosed before birth or after delivery. Individuals may be born with a cleft lip, a cleft palate, or both together. Clefts of the lip and palate may be one sided (unilateral), affect two sides (bilateral) and may be complete or incomplete. A cleft may be associated with a syndrome or genetic cause. It is essential for babies born with a cleft palate to establish an early feeding regimen, as a cleft in the palate will make it impossible for babies to breastfeed. Babies with a cleft palate will need to use a bottle that has a “jaw action” nipple, such as the Dr. Brown’s special feeder, a pigeon nipple, or the Haberman system, to name a few. A baby with an isolated cleft lip can usually breastfeed. Dr. Magill is highly experienced and fellowship trained in caring for patients of all ages that are affected by a cleft lip or palate. Lip repair is usually undertaken at 6 months of age, and palate repair is often performed between 11 and 13 months of age. Both surgeries are done under the care of a pediatric anesthesiologist and Dr. Magill at the Children’s Hospital at Providence Medical Center. Infants are often able to go home the day after a lip repair, but children typically have an overnight stay for monitoring after palate repair (palatoplasty).
Team care for children with a cleft lip or palate is essential. There are several cleft teams in Alaska that meet on a regular basis to evaluate children and assess their needs. Typically, cleft teams evaluate speech, nutrition, hearing, dental, orthodontic and oral surgery needs, and also include a pediatrician and facial plastic surgery specialist. Children benefit from team evaluation early on to make sure speech, hearing and communication are assessed. Dr. Magill is the medical director and founder of the Cleft and Craniofacial team at Providence Hospital. Dr. Magill serves on the Fairbanks Cleft Team, as well. There is also an established cleft team through the Southcentral foundation that meets at the Alaska Native Medical Center. Dr. Magill works with the Global Smile Foundation to provide cleft care and surgery for underserved children in South America. Dr. Magill highly recommends seeking medical and surgical care with an experienced physician who regularly treats cleft lip and palate in their practice.
Frequently Asked Questions
What causes a cleft lip or palate?
It is believed that a combination of genetic and environmental factors cause clefts in the lip and/or palate. Cleft lip and palate are among the most common birth defects and can occur along with inherited genetic changes or syndromes.
What surgeries are needed if you have a cleft lip or palate?
For babies born with a cleft lip, lip repair and primary cleft tip rhinoplasty are typically undertaken at 6 months of age. In severe cases of bilateral cleft lip, a tertiary center referral may be necessary to ensure the best outcome. Cleft of the palate are repaired between 11 and 13 months of age. Bilateral myringotomy tubes (ear tubes) are often placed at the time of palate repair because a cleft in the palate almost universally leads to some Eustachian tube dysfunction or tendency for fluid in the middle ear space. Later on in childhood, some individuals with a cleft palate may need a surgery to help with speech if the palate is too short or is not mobile. Dental and orthodontic surgeries may also be needed at the face grows. To support permanent dentition, a bone graft may be needed in the site of the cleft along the gumline. In the teenage years, jaw surgery and nose surgery may be needed.
What resources are available for cleft lip and palate patients?
There are many national and international resources that can provide information to families and caregivers about cleft lip and palate care. Dr. Magill recommends: