Understanding Cleft Lip and Palate Repair

Clefts in the lip and/or palate occur when fetal tissues fail to fuse properly during development. These two conditions affect about 1 in 1,000 babies every year, making them the fourth most common birth defect in the US. Since the lip and the palate develop at different times, it’s possible for a baby to be born with a cleft lip, a cleft palate, or both.

At Oral & Facial Surgery of Mississippi in Flowood, Mississippi, Dr. Michael Nichols and our team of experts understand how important it is for a child to have a fully formed lip and palate. That’s why we specialize in performing surgical cleft lip and palate repair for those born with the defects. Here’s what you should know about the conditions and what can be done to correct them.

Lip and palate development

The fetus’s lips form between weeks four and seven during pregnancy. As the baby develops, body tissue and special cells from both sides of the head grow toward the center, joining together to make the face and its features.

A cleft lip results when the lip tissue doesn’t join completely together before birth, leaving an opening in the upper lip — anywhere from a small slit to a large hole that extends from the lip into the nose. The cleft can appear on one or both sides of the lip, and children with a cleft lip often also have a cleft palate.

The palate (roof of the mouth) forms between weeks four and nine during pregnancy, and it functions to separate the nasal cavity from the mouth. If the tissue that makes up the roof of the mouth fails to join together completely, it results in a cleft palate. For some babies, the opening occurs in both the front and back parts of the palate; for others, only part of the palate is open.

Problems associated with cleft lips and palates

Cleft lips and palates are more than just defects in appearance; they create a host of problems that can affect a baby’s normal development.

Eating issues

A normal lip is necessary for sucking, so a baby with a cleft may have trouble eating at first. And with a cleft in the palate, food and liquids can move from the mouth back into the nose. Most babies quickly learn how to bypass these problems, so feeding, while not completely normal, isn’t a huge problem.

Ear infections and hearing loss

Children with a cleft palate are more prone to fluid buildup in the middle ear, which can lead to ear infections. If the infections aren’t treated, the baby may experience hearing loss.

Speech problems

The palate plays an extremely important role in speech, because it prevents air from blowing out of your nose instead of your mouth when you speak. As a result, children with a cleft palate may have difficulty speaking, their voices may sound very nasal, and their speech may be hard to understand, even after palate repair. Not all children have these problems, but for those who do, surgical repair may fix them completely.

Cleft lip and palate repair

Both a cleft lip and a cleft palate generally require surgery to repair the damage and restore normal function.

Most cleft lip repairs are performed when the child is about 10 weeks old. The goals for the procedure include closing the separation, restoring muscle function, and providing a normal shape to the mouth. The nostril deformity may be improved, or it may require further surgery to correct.

The surgeon can safely perform surgery for a cleft palate when the child is 7 to 18 months old, but that depends on the individual. If the child has additional health problems, the procedure may be delayed.

The major goals of surgery include closing the separation between the roof of the mouth and the nose, reconnecting the muscles that make the palate work, and making the palate long enough so it can function properly. The child may also need to have tubes placed in the eardrums to allow for adequate fluid drainage.

About 30-40% of children with a cleft palate need additional surgeries to improve their speech, which is assessed between ages 4 and 5. The doctor uses a nasopharyngeal scope to check the movement of the palate and throat, and he makes the decision together with a speech pathologist. If the surgery is required, he performs it when the child is about five years old.

If your child has a cleft lip and/or palate, Dr. Nichols at Oral & Facial Surgery of Mississippi has the expertise necessary to perform many of the surgeries required to repair the deficits caused by the cleft. Learn more by calling our office at 601-282-9290 to schedule a consultation with Dr. Nichols.