Cleft Lip and Palate
Clefts of the lip and palate occur in about one of every 750 births. With properly timed surgery, orthodontics, and speech therapy, both appearance and function can be dramatically improved.
Integrated Cleft Lip and Palate Care
Clefts of the lip and palate occur in roughly one out of 750 births, with environmental, socioeconomic, and genetic factors all playing a role. The vast majority of cases are isolated and not part of a larger syndrome of congenital deformities.
A cleft lip creates a dramatic cosmetic difference that can be frightening for parents, while a cleft palate causes significant long-term functional problems. The most critical is its effect on speech, since the palate cannot close to separate the oral and nasal cavities.
The good news: both the cosmetic and functional challenges can be dramatically improved with properly timed reconstructive surgery, orthodontics, and speech therapy, delivered as one integrated plan.
Team-Based Treatment
The best results come from a team of specialists, including a plastic surgeon, an oral surgeon, and a speech therapist.
Carefully Timed Surgery
Lip repair typically happens at 3 to 6 months of age, with palate repair following at 9 to 18 months.
Support From Diagnosis
Referral is appropriate as soon as a cleft is diagnosed, sometimes even before birth when found in utero.
Early Care for Your Baby
A baby with a cleft lip or palate should have a thorough exam to rule out any associated abnormalities, and your pediatrician or family physician should follow your child closely to ensure adequate weight gain.
Feeding
Babies with only a cleft lip are generally able to nurse without difficulty. Babies with a cleft palate may not create enough suction to get full nutrition from breastfeeding alone and often need supplemental bottle feeding with special bottles and nipples designed for cleft care.
Ear Infections
Children with clefts have a high incidence of chronic middle-ear infections. They need close follow-up for this and frequently benefit from myringotomy tubes.
Early Referral Helps Parents Prepare
Referral to a plastic surgeon is appropriate as soon as the diagnosis is made. This lets the surgeon assess the extent of the cleft, explain the proposed treatment plan, and reassure you about what will happen, when, and what the long-term outlook holds for your child.
In some cases a cleft can be diagnosed in utero, and parents can benefit from meeting with a plastic surgeon before birth. Genetic counseling is also generally recommended to help families understand the risk of similar conditions in future children and grandchildren.
Surgical Timing and the Team Approach
Surgery to repair a cleft lip is typically performed when a child is between 3 and 6 months old, with cleft palate repair usually following between 9 and 18 months of age. In some cases a two-stage approach is used, closing the lip first and repairing the palate later.
This reconstructive surgery is complex, so it is important to choose a surgeon with significant experience in cleft repair. The best results come from a coordinated team that includes a plastic surgeon, an oral surgeon, and a speech therapist.
A Typical Treatment Timeline
Diagnosis to 3 months: plastic surgery consultation and parent education.
Around 3 to 6 months: surgical repair of the cleft lip.
Around 9 to 18 months: surgical repair of the cleft palate.
Ages 3 to 5: potential revisions of the lip, nose, or palate, with ongoing speech therapy as recommended.
Ages 7 to 10: alveolar bone grafting and orthodontic work.
Late teens: final cosmetic revisions, if needed.
“The results are fantastic! We took Jordan out of town for a previous surgery that had disappointing results. I wish we had taken him to Dr. Baertsch much earlier in the treatment process. His work will make a difference in our son’s life.”
Elizabeth · Jordan’s Mother
Jordan was born with a cleft lip and palate, repaired in childhood. As a teenager he was left with a residual deformity that bothered him: some retraction of the lip, a noticeable scar, and a nasal deformity that caused substantial asymmetry. He underwent a complete lip revision and reconstructive rhinoplasty with cartilage grafting. His symmetry is much improved, and he is pleased with the results.