Cleft Lip and Palate
Cleft lip and palate deformities are the most common birth defects involving the head and neck, affecting approximately one in 690 babies born in the United States. A child may be born with a cleft lip, a cleft palate, or both.
Some babies are born with a cleft lip, which is a split in the lip that can go up to the nose. Some infants with cleft lip only have an incomplete cleft, while others will have a complete cleft with an opening that goes from the red part through the bottom of the nose, widening the nostril on the side of the cleft. The gum can be completely split, partly split, or not split at all.
Frequently Asked Questions About Having Both Cleft Lip and Palate
Some babies are born with both a cleft lip and cleft palate. These children need two surgeries within the first year or so after birth: cleft lip repair at three to six months, and cleft palate repair between 12 and 18 months.
Some babies are born with a cleft lip and palate, which is a split in the lip that extends into the gums and the roof of the mouth. The cleft lip is called complete when the opening goes through the lip and nose. A cleft palate is called complete when the separation in the roof of the mouth extends from the gum line to the back of the palate. A baby with a cleft lip and palate has several needs that we address in our treatment plan.
Parents should expect two surgeries within the first year and a half after birth: cleft lip repair and cleft palate repair.
Before surgery, our specialists sometimes recommend nasoalveolar molding, which is a special technique to bring the gums and lip together with special dental molds and tape. The dentist will take the impression of your baby’s mouth in our office and create the appliance. We have found this makes the surgery easier and provides the best possible result.
Cleft Lip Repair: This first surgery to reconstruct the lip occurs between three to six months of age to connect both sides of the lip and bring the nostril together. Your baby will be asleep for the operation. The specialist who gives the sleeping medications, an anesthesiologist, is one of a staff of doctors trained and experienced in giving anesthesia to young infants and children.
Cleft Palate Repair: The next operation is the repair of the palate, usually done between 12 to 18 months of age. Frequently, infants with cleft palate can develop fluid build-up in the ears, which can lead to problems with hearing or multiple ear infections. Children with cleft palate are especially prone to these problems. If necessary, ear tubes can be placed at the same time as cleft palate repair.
Alveolar Bone Grafting: This is a procedure to fill the gap in the gums (between the teeth) with new bone. The surgery is usually performed between eight and twelve years of age. The timing depends on the development of your child’s teeth and is different for each person. This will be determined by our dental specialists. Orthodontics (braces) are usually placed either before and/or after the bone grafting procedure. Your dental specialist will talk to you about the best timing for braces, as well as any other dental procedures that may be necessary.
- Two weeks: pre-surgical treatment of nasoalveolar molding, if indicated. Visits to dental clinic every one to two weeks until lip repair.
- One month: first office visit with Dr. Woo about possible plastic surgery
- Two to four months: first visit with the craniofacial team
- Three to six months: cleft lip repair
- Nine to twelve months: craniofacial team visit
- Twelve to eighteen months: cleft palate repair about ear tube placement, if needed
- Two to three years: speech evaluation, craniofacial team visit annually
- Six to seven years: evaluation by orthodontist to plan for upcoming orthodontic treatment, craniofacial team visit annually
- Eight to eleven years: phase one orthodontics with palate expansion, removal of retained baby teeth; and braces before Alveolar Bone Graft (ABG), craniofacial team visit annually
- Nine to twelve years: ABG to close gum cleft and/or premaxillary osteotomy, craniofacial team visit annually
- Twelve to fourteen years: phase two orthodontics of full orthodontic treatment to coordinate bite and relieve crowding, craniofacial team visits every one to two years
- Sixteen to twenty years: final touch-up surgeries, if indicated.
- Phase III orthodontics: orthodontic treatment for correction of jaw misalignment, braces 12 months before and six to twelve months after jaw surgery, craniofacial team visits every one to two years
- Jaw surgery to properly align the upper and lower jaws and create a proper bite, craniofacial team visits every one to two years
Alveolar Bone Grafting
This is a procedure to fill the gap in the gums (between the teeth) with new bone. The surgery is usually performed between 8 and 12 years of age. The timing depends on the development of your child’s teeth and is different for each person. This will be determined by our dental specialists.
Orthodontics (braces) are usually placed before and/or after the bone grafting procedure. Your dental specialist will talk to you about the best timing for braces, as well as any other dental procedures that may be necessary.
Nasoalveolar Molding (NAM) for Cleft Lip
Before surgery for cleft lip repair, our specialists sometimes recommend an orthopedic treatment called nasoalveolar molding (NAM). This process reshapes the gum, lip, and nostrils with special dental molds and tape. Hasbro Children’s Hospital is one of the few institutions in New England to provide this unique service.