WHAT IS A CLEFT LIP AND PALATE?
A cleft is a birth defect where the two halves of the palate and/or the lip do not fuse properly, leaving an open space or ‘cleft’. A cleft in the roof of the mouth, or palate, is known as a cleft palate whereas a cleft between the two halves of the lip is known as a cleft lip. The cause is unknown, although it is thought that genetic factors play a role in a small proportion of cases.
Since the lip and the palate develop separately, it is possible for a child to have a cleft lip, a cleft palate, or variations of both. This can occur on one side of the face only (unilateral) or on both sides (bilateral).
1 in 700 babies are born with a cleft lip and/or palate. This equates to about 250 Australian children each year.
THE SURGICAL PROCEDURE & PLAN
Surgery can repair most clefts so that the child’s appearance and speech develop normally. However, children born with a cleft lip or palate may need the skills of several medical professionals to correct the problems associated with the cleft. In addition to needing plastic surgery to repair the opening, these children may have problems with their feeding and their teeth, their hearing, their speech, and their psychological development as they grow up. Parents should seek the help of a cleft lip and palate team as early as possible.
Depending on the location and severity of the cleft, treatment is generally staged:
- Lip +/- anterior hard palate repair 3-6 months
- Soft Palate – 9 to 12 months often with grommets placed at this time
- Pharyngoplasty if speech does not develop normally 5-7 years
- Bone grafts for the upper jaw 9-10 years of age
- Ongoing dental and orthodontic care
- Jaw bone realignment (Orthognathic surgery)
- Subsequent cosmetic operations – these may be necessary as the child matures ie rhinoplasty, lip revision
Your child may need some or all of these treatments, depending on their condition. Dr Kirstin Miteff will be able to better advise what is best for your child.
Dr. Miteff performs surgery at :
Private Hospitals
- Lingard Private Hospital
- Warners Bay Private Hospital
Public Hospitals
- John Hunter Children’s Hospital
- Belmont District Hospital (>14 years)
MEDICARE CRITERIA
Cleft lip and palate surgery is generally considered a reconstructive procedure and may be covered by your private health fund. The Medicare Australia Cleft Lip and Cleft Palate Scheme can help families meet treatment costs for specialised services for cleft lip and cleft palate conditions.
With any procedure you choose to undergo, potential risks and complications can occur, and it is vital to understand them before deciding on surgery.
Some specific risks and complications may include:
CLEFT LIP SURGERY
The most common problem for this surgery is asymmetry, where one side of the mouth and nose does not match the other side. Further surgery may be necessary to correct any irregularities.
CLEFT PALATE SURGERY
In cleft palate surgery, the goal is to close the opening in the roof of the mouth so the child can eat and learn to speak properly. Occasionally, poor healing in the palate or poor speech may require a second operation.
Children with a cleft palate are also particularly prone to ear infections because the cleft can interfere with the function of the middle ear. To permit proper drainage and air circulation, a Specialist Ear-Nose-and-Throat Surgeon on the Cleft Palate Team may recommend that a small plastic ventilation tube be inserted in the eardrum.
Some other possible cleft surgery risks may include:
- Allergies to tape, suture materials and glues, topical preparations or injected agents
- Anaesthesia risks
- Bleeding
- Damage to deeper structures – such as nerves, blood vessels, muscles and auditory canal can occur and may be temporary or permanent
- Infection
- Irregular healing of scars including shortening, thickening or overgrowth
- Poor healing of incisions
- Possibility of revisional surgery
- Residual irregularities and asymmetries in the lip or nose
- Respiratory problems after surgery
Dr Kirstin Miteff will go into more depth about the associated risks and complications during your consultation.