Cleft Lip & Palate

In the beginning stages of pregnancy, separate areas of the face develop individually and then join together, including the right and left sides of the roof of the mouth and lips. A cleft results if these particular parts do not join correctly, and the sections don’t meet. Cleft lip is diagnosed if the separation occurs in the upper lip.

A correctly formed lip is not only important for a normal facial appearance but for sucking and to be able to make certain sounds during speech, as well. A cleft lip is a particular medical condition that creates an opening in the upper lip between the mouth and the nose. Its appearance looks as though there is a split in the lip. The severity of the cleft lip can range dramatically, to a slight notch in the colored portion of the lip to a complete separation in one or both sides of the lip extending up and into the nose. A unilateral cleft is a cleft on one side. A bilateral cleft, is one that occurs on both sides.

A cleft in the gum may occur in conjunction with a cleft lip. This condition can range from a small notch in the gum to a complete division of the gum into separate parts. Cleft palate is a similar defect in the roof of the mouth.

Cleft Palate

The roof of your mouth is called the palate. It is made up of muscle and bone and is covered by a thin piece of wet skin that forms the red covering inside the mouth. Its purpose is to separate your nose from your mouth. You can feel your own palate by running your tongue over the top of your mouth.  The palate plays an important role during speech by preventing air from blowing out of your nose instead of your mouth when you talk. The palate is also very important when eating, as it prevents liquids and food from going up into your nose.

Just like a cleft lip, a cleft palate occurs in the beginning stages of pregnancy when separate areas of the face develop individually and do not join together correctly. A cleft palate results when there is an opening in the roof of the mouth. The front of the palate is called the hard palate and the back of the palate is called the soft palate. The severity of a cleft palate can range from just a small opening at the back of the soft palate to an entire separation of the roof of the mouth (both hard and soft palate).

Occasionally a baby born with a cleft palate may have a smaller chin and some of the babies with this combination may also have trouble with breathing easily. This particular condition is called a Pierre Robin sequence.

Cleft defects occur in about one out of every 800 babies born. Since the lip and palate develop individually, it is possible for a baby to be born with a cleft lip, palate or both.

Children born with one or both of these medical conditions will typically need the professional skills of multiple medical professionals to manage the problems associated with the defect such as speech, feeding, hearing and also psychological development. In most cases, surgery is recommended for these children born with the defect. Positive results can be achieved when the surgery or surgeries are done by a qualified, experienced oral and maxillofacial surgeon such as Dr. Reisman.

Cleft Lip Treatment

Cleft lip surgery is typically performed when the child is about ten years of age. The goal of this particular surgery is to close the separation, restore muscle function and to also provide a normal shape to the mouth. An improvement in the nostril deformity may be a result of the procedure or may require a subsequent surgery to get the best results.

Cleft Palate Treatment

A cleft palate can be initially treated with surgery safely when the child is between 7 and 18 months of age. The range of age when this surgery can be done typically depends upon the individual child and his/her own unique situation. For example, if the child has experienced any other associated health problems, it is probable that the surgery will be delayed.

The major goals of surgery are to:

  • Reconnect the muscles that are necessary in order to make the palate work properly.
  • Close the gap or hole between the nose and the roof of the mouth.
  • Make the repaired palate long enough so that the palate can perform its proper function.

There are many different techniques that surgeons will use to achieve these goals. The particular techniques may vary between surgeons and should be discussed between the parents of the patient and the surgeon prior to the surgery.

The cleft hard palate is typically repaired when the child is between the ages of 8 and 12 when the cuspid teeth start to develop. The procedure includes the placement of a piece of bone from the hip into the bony defect, and closure of the communication from the nose to the gum tissue in three layers. It may also be performed in adults and teenagers as an individual procedure by itself or combined with corrective jaw surgery.

What Can Be Expected After The Surgery?

Immediately following the surgery and the palate has been fixed, children will instantly have a much easier time in swallowing liquids and food. However, in about 1 out of every 5 children following a cleft palate repair, a portion of the repair will split, causing a new hole to form between the mouth and the nose. If the hole is small, it may only result in an occasional minor leaking of fluids into the nose. However, if the hole is large, it can cause significant eating problems, and most importantly, can affect the child’s speech. This hole is called a “fistula,” and will likely need further surgery to correct.

Sialoendoscopy

Minimally invasive surgery with endoscopy allows treatment of salivary gland disorders that had once previously required the removal of salivary glands. A 1.3mm camera is used to successfully examine and treat the salivary gland diseases such as blockages (stones) and narrowing (stenosis).  Dr. Reisman has trained with doctors from Europe and Israel at their hospitals and is the first surgeon in the U.S. to acquire this unique equipment to treat these particular salivary gland disorders.