Cleft lip and palate surgery

Cleft lip before	Cleft lip after

Cleft lip before	Cleft lip after

About Cleft lips and palates

A cleft lip is a split in the upper lip, a cleft palate is a split in the roof of the mouth. They occur during early development in the womb, when the upper lip or palate doesn't join together properly.

Cleft lips or palates occur in 1 in 600 to 1000 births, making it one of the most common major birth defects. Clefts occur more often in kids of Asian, Latino, or Native American descent.

The three common kinds of clefts are:

• cleft lip without a cleft palate
• cleft palate without a cleft lip
• cleft lip and cleft palate together

In addition, clefts can occur on one side of the mouth (unilateral cleft) or on both sides of the mouth (bilateral cleft).

The good news is that both cleft lip and cleft palate are treatable. Most kids born with these can have reconstructive surgery within the first 12 to 18 months of life to correct the defect and significantly improve facial appearance.

Development of a cleft lip or palate

Each of us had a cleft lip and cleft palate during the early weeks of development in our mother's womb. Normally, the tissues that form the palate (the roof of your mouth) and the upper lip come together in the middle and join (fuse). You can see the lines of fusion in the "Cupid's bow" under your own nose, and feel the ridge and line in the middle of your palate (the roof of your mouth). If your baby has a cleft, this fusion did not happen when he or she was developing.

During the first six to eight weeks of pregnancy, the shape of the embryo's head is formed. The lips and palate originate from three areas of the baby's developing face. These areas are also called prominences. They are the Central or "Frontal Nasal" prominence (green in the illustration), the Left "Maxillary" prominence (yellow), and the Right "Maxillary" prominence (yellow). The Central prominence will grow and become the infant's forehead, nose, middle portion of the upper lip (called the philtrum or Cupid's bow) and the primary palate, which is the part of the upper jaw that holds the middle four teeth. The Left and Right "Maxillary" prominences will grow and become the lower face, the lower lip and jaw (all but the middle portion of the upper lip and jaw), and the "secondary" palate (this is the part of the palate from behind the middle four upper teeth to the back of the mouth).

Embryo at 7 weeks.		Embryo at 10 weeks

If these tissues fail to meet, a gap appears where the tissues should have joined (fused). This may happen in any single joining site, or simultaneously in several or all of them. This is what we call a cleft lip or cleft palate

About the causes of Cleft lip and palate

In most cases, we simply don't know why lip and palate development go wrong.

Race and gender play a small role. Cleft lips and palates are most common in Asians. They are less common in whites and least common in blacks. Boys are more often affected than girls.

In some families, cleft lip and palate appear in several family members, so heredity is important. Sometimes substances in the environment, called teratogens, may be associated with clefts. But most babies with clefts have no known relatives with cleft lip or palate and no known exposure to teratogens. A few babies with cleft lip and palate also have other abnormalities.

The Cleft lip and palate team

Individuals born with cleft palate may face a number of challenges, including anatomical deformities, dental malocclusion, hearing impairment, and speech disorder.

There may be many people involved in management of a cleft abnormality for your child, because the skills of many different areas are needed to help with the problems that can occur with cleft abnormalities.

A cleft lip and palate can be treated very well these days. So-called Cleft teams are in charge of treatment. Cleft teams can be differentiated into closed (all members work in one hospital) and open (members also cooperate from a distance) teams. We work in an open or closed team. This means the Cleft operations take place in Marbella, but if you want you can visit your local pediatrician, orthodontist, ENT specialist, speech therapist and dentist.

The following are some of the members of the cleft lip and palate team:

• maxillofacial surgeon - a surgeon with specialized training in the diagnosis and treatment of skeletal abnormalities of the skull, facial bones, and soft tissues; will work closely with the orthodontists and other specialists to coordinate a surgical plan.
  
  
• pediatrician - a physician who will follow the child as he/she grows and help coordinate the multiple specialists involved.

  
  
• orthodontist - a dentist who evaluates the position and alignment of your child's teeth and coordinates a treatment plan with the surgeon and other specialists.

  
  
• pediatric dentist - a dentist who evaluates and cares for your child's teeth.

  
  
• speech and language specialist - a professional who will perform a comprehensive speech evaluation to assess communicative abilities and who will closely monitor your child throughout all developmental stages.
  
  
• otolaryngologist (ear-nose-throat specialist) - a physician who will assist in the evaluation and management of ear infections and hearing loss that may be side effects of your child's cleft abnormality.

  
  
• audiologist (hearing specialist) - a professional who will assist in the evaluation and management of hearing difficulties your child may have.

  
  
• nurse team coordinator - a registered nurse who combines experience in pediatric nursing with specialization in the care of your child and acts as liaison between your family and the cleft team.


The specialists will evaluate your child's progress regularly, and monitor hearing, speech, nutrition, teeth, and emotional state. They'll share their recommendations with you, and can forward their evaluation to your child's school and any speech therapists that your child may be working with.

Book for surgeons about Cleft lip surgery

In July 2008 Bart van de Ven, Joel Defrancq and Ellen Defrancq published the book "Cleft Lip Surgery, a Practical Guide".