Cleft Lip / Palate Info
At Birth
The diagnosis is confirmed at delivery and a detailed assessment is made. A member of our team will usually visit you and your child in hospital if you live in the metropolitan area. During the early days the child may experience some feeding difficulties because of inability of the lips to make a seal, or for the palate to close off the mouth from the nose. We can assist you and the staff of the maternity unit on appropriate feeding techniques, and we are keen to preserve breast-feeding where possible.
The First Year
During this time the surgical correction of the lip and the nose takes place. The timing of this depends on the severity of the cleft and the health of the baby. The palate repair is usually performed some time later (usually after six months) when the components of the palate have grown to a reasonable size and before the baby starts to develop speech patterns.
Also, during the first year (usually at about four months) there can be problems with hearing. The child with a cleft frequently experiences problems with normal drainage of fluid from the middle ear cavities, into the throat. This causes build-up of fluid behind the ear drum which can result in pressure and a degree of hearing loss. Your child will be routinely tested for this and may need small tubes placed in the ear drum to drain the fluid and equalise the pressure. Continued monitoring of hearing in the early years is necessary. However hearing improves with growth and, by the end of primary school, may present no further problems.
The Preschool Years
During this time the major concerns are maintenance of good teeth and the development of speech. A small percentage of children who have had their palate repaired cannot speak properly without some air escaping out the nose and mouth – the palate is a trap-door between the mouth and nose and it may not be able to close properly. Detailed speech assessments are made in the preschool years and, if necessary, an extra palatal operation may be done to ensure proper closure. During this time a child should see a paediatric dentist and become registered on the Federal Government cleft lip and palate scheme.
School Age
The orthodontist usually becomes involved with the child’s management when the secondary teeth start to appear. Where there is a cleft in the gum or palate, the secondary canine teeth may not be able to erupt. In most children a bone graft is inserted into the gum to stabilise the situation and to allow teeth to erupt. This is usually done somewhere between eight years of age and puberty, depending on the individual child’s tooth development. If there is insufficient upper jaw growth, some patients may require surgical correction to balance the jaws.
Puberty and Beyond
During puberty there is a rapid growth phase for the child and this includes the facial structures. Parts of the face in a child with a cleft may not have the growth potential of a normal child, which are accentuated during this period. Virtually all cleft children have a nasal deformity that is well-corrected at the original lip operation during the first year of life. However, there are residual growth discrepancies and these are often made worse by the child also developing the ‘family nose’. Most children will require further nasal correction after puberty and may even need minor lip revision.
More importantly, in some children with severe clefts the mid-part of the face does not grow forward as much as one would like. For these children, in the later teenage years the jaws can be moved with incisions inside the mouth to create optimal facial harmony and normal dentition.
Naturally, not all children with clefts will require all the treatments mentioned above. It really depends on the severity of the cleft.
A cleft lip or palate is a problem that usually requires long-term management by a team of specialists. Our cleft lip/palate team is dedicated to working with parents to provide the child with the best possible surgery, dentistry, speech pathology, school planning and emotional support.
In this booklet, members of our team have tried to answer a series of questions most frequently asked by parents. We hope that this information will provide a better understanding of the situation and what can be done for your child in the years ahead.
Because techniques are forever evolving, advances in management may mean that some aspects of treatment will be different for your child in the future. However, having your child’s problem managed by a major cleft team will ensure that recent techniques are always available for your child.
A cleft lip or cleft palate need not be a disability for your child.
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