Smiling From The Start
During early pregnancy, separate areas of the face develop individually and then join together, including the left and right sides of the roof of the mouth and lips. However, if some parts do not join properly, sections don’t meet and the result is a cleft. If the separation occurs in the upper lip, the child is said to have a cleft lip.
A completely formed lip is important not only for a normal facial appearance but also for sucking and to form certain sounds made during speech. A cleft lip is a condition that creates an opening in the upper lip between the mouth and nose. It looks as though there is a split in the lip. It can range from a slight notch in the colored portion of the lip to complete separation in one or both sides of the lip extending up and into the nose. A cleft on one side is called a unilateral cleft. If a cleft occurs on both sides, it is called a bilateral cleft.A cleft in the gum may occur in association with a cleft lip. This may range from a small notch in the gum to a complete division of the gum into separate parts. A similar defect in the roof of the mouth is called a cleft palate.
Cleft lip surgery is usually performed when the child is about ten weeks old, depending on the growth and development of that particular child. The goal of surgery is to close the separation, restore muscle function, and provide a normal shape to the mouth and nose. The nostril deformity may be improved as a result of the procedure or may require a subsequent surgery.
Posterior Palate - The back portion of a cleft palate is initially treated with surgery when the child begins to make sounds and form speech, between 7 to 18 months old. This depends upon the individual child and his/her own situation. For example, if the child has other associated health problems, it is likely that the surgery will be delayed. The major goals of this surgery are to:
1. Close the gap or hole between the roof of the mouth and the nose.
2. Reconnect the muscles that make the palate work.
3. Make the repaired palate long enough so that the palate can perform its function properly.
After the palate has been fixed, children will immediately have an easier time in swallowing food and liquids. However, in about one out of every five children following cleft palate repair, a portion of the repair will split, causing a new hole to form between the nose and mouth. If small, this hole may result in only an occasional minor leakage of fluids into the nose. If large however, it can cause significant eating problems, and most importantly, can even affect how the child speaks. This hole is referred to as a “fistula,” and may need further surgery to correct.
Anterior Palate – The front portion of the cleft palate is generally repaired between the ages of6 and 12 depending on the dental development of the child. The procedure involves placement of a bone graft into the bony defect of the upper jaw,and closure of the communication between the noseand the mouth. It may also be performed in teenagers and adults as an individual procedure or combined with corrective jaw surgery.
The major goals of this surgery are to:
1. Provide bony continuity of the upper jaw bone
2. Provide bony support for the base of the nose
3. Provide bony support for the developing permanent teeth
4. Close any residual communications between the mouth and nasal cavity