Cleft Lip and Cleft Palate Repair
Care at Every Stage of your Child's Development
If your child has a cleft lip and/or cleft palate, you want an experienced and compassionate medical team to provide care at every stage of your child’s development. Our team of specialists uses the latest treatment options to minimize how many procedures your child will need. Our goal is to give your child the best outcome possible, with results that last a lifetime.
Does Your Child Need Cleft Palate Repair Surgery?
Cleft lip and cleft palate are very common, treatable birth defects that occur when the left and right sides of a baby’s face fail to grow together during pregnancy. Cleft lip and cleft palate is typically an isolated defect that occurs randomly and is not hereditary, however, it can be part of a syndrome that includes other congenital defects. Having one child with a cleft lip or cleft palate only slightly increases the risk of a future child being affected.
While cleft lip and cleft palate are unique to each child, they fall into several basic categories depending upon the part of the facial anatomy that is affected. Whatever type and severity of cleft that affects your child, it is important to know that all of these combinations are very treatable. We believe great care starts before birth with prenatal counseling and follows your child as he or she grows to young adulthood.
Is Your Child a Candidate for the NAM Device?
Nasoalveolar molding (NAM) has been shown to greatly improve outcomes in certain types of clefts – especially in the appearance of the nose. The custom device is similar to an orthodontic retainer; it gently guides the two sides of your baby’s face together over time. This reduces the width of the cleft and makes future surgical repair easier. Moreover, the NAM device shapes the nostril, which improves the aesthetic result and minimizes scarring.
Our team includes one of the original developers of the NAM device for cleft palate. Having one of the original developers of the NAM device on your child’s team gives you a level of expertise that is unmatched at other hospitals in the region. This is very important as some craniofacial orthodontists do not have the necessary experience or technical ability to provide NAM in a safe and effective manner. Your child will be evaluated to see if he or she will benefit from the NAM device during one of his or her initial evaluations.
Choosing a Cleft Palate or Cleft Lip Repair Program
There are many factors to consider when deciding which group of surgeons and specialists will care for your child. You can feel confident in choosing Duke for your child’s cleft palate and/or cleft palate repair.
The treatment of cleft lip and cleft palate is complex. Our team's strength is evident in the extent of our medical and surgical expertise. Your child will be evaluated and treated by many specialists including plastic and craniofacial surgeons, oral surgeons and orthodontists, ear, nose and throat specialists, audiology and speech therapy professionals, clinical social workers and others, as needed. In addition, our team is managed by a dedicated team coordinator, who ensures that your child’s care is provided in a timely, coordinated and effective manner. Your child will be seen at least once a year to monitor his or her progress or provide interventions.
Providing convenient, comprehensive care to your child is important. Your child will be seen by each member of the team at every clinic visit, in one convenient location. At the end of the day, our team meets to discuss your child in great detail. This allows us to tailor the treatment plan to meet your child’s individual needs. Our team coordinator then provides you with a summary of the team visit, the team plan, and next steps.
Prenatal counseling helps you prepare. Often, a baby’s cleft may be diagnosed prenatally during a routine fetal ultrasound during the second trimester of pregnancy. Understandably, this can be very stressful for expectant parents. At your prenatal counseling consultation, you will meet our team coordinator, craniofacial surgeon, craniofacial orthodontist, speech/language pathologist, and social worker. At this initial consultation, we’ll cover:
- Background on cleft lip/palate
- The treatment strategy we use
- Ways you can feed your baby effectively
We’ll also provide you with reassurance and support. It is important to know that you are not in this alone. Our team is here to help at every step of the way.
Newborns need care as soon as possible. Parents who did not have access to the prenatal consultation, or who didn’t know their baby would be affected by a cleft until after birth, are just as worried about the situation. We make every effort to see newborns as soon as possible so that we can provide guidance and support relating to feeding and begin treatment planning.
Cleft lip or cleft palate treatment can be fine-tuned for older children. Children with cleft lip and/or cleft palate who are adopted from abroad, and whose families have recently relocated to the Durham area have different needs from babies. We work with older children with a still-unrepaired cleft, as well as children who are new to the area and midway through treatment started by another team. We fine-tune our treatment strategy to fit your child's individual needs.
You need long-term partners in your child’s care. Your child’s individualized treatment plan and surgical timeline extend into young adulthood. We use the latest research to offer the most current treatment options for cleft lip and cleft palate. Our proactive approach to your child’s care prevents normal challenges from becoming significant problems. It also gives you peace of mind when you know what to expect every step of the way.
You will benefit from ongoing support for your emotional, social and psychological needs. You’ll find a strong network of support—and friendships—among the families who see one another frequently during annual visits to the clinic. In addition, our social worker will educate you about your child’s developmental needs, and provide information about financial assistance and other resources available at Duke and in your community.
Customized treatment plan and surgical itinerary. During your child’s initial evaluation, our doctors will assess which structures are affected by the cleft—the upper lip, alveolus (dental arch, or gum line), and palate (roof of the mouth). Based on the type of cleft affecting your child, the team will develop a customized treatment plan and surgical itinerary.
CLEFT LIP AND CLEFT PALATE REPAIR
Cleft Lip and Cleft Palate Surgery
Your child's care may include one or more of the following procedures.
Cheiloplasty closes the opening in the lip—both inside and outside the mouth, and is typically done when the child is around 3-5 months old. At the same time, our surgeons may correct the nasal distortion or asymmetry, where indicated.
GPP connects the two sides of the gum line to encourage bone to grow across from one side to the other. GPP has been shown to decrease the need for future bone grafting. Our team combines GPP with either the cleft lip repair or cleft palate repair whenever possible; it cannot be done in cases where the gap between the gums is very wide.
Palatoplasty closes the opening in the palate by bringing together the soft tissue on either side of the cleft and aligning them properly. It also properly aligns the muscles of the palate to improve speech. The optimal age for this procedure is 9-12 months of age.
These procedures correct velopharyngeal incompetence that result from abnormal function of the muscles of the soft palate, resulting in hypernasal speech. A flap of muscle and mucosa is created in the back of the throat and attached to the palate to correct airflow and eliminate or reduce the degree of hypernasal speech. This procedure is not always required. Our speech therapists will monitor your child closely after the cleft palate repair to determine if this procedure would be beneficial. If needed, it may be performed when a child is 3-5 years old.
A bone graft is placed to fill the gap where bone is missing in the upper jaw. It is used for children with a complete cleft lip that involves the lip, palate and gum line and takes place between ages 7-9. The bone graft used is the spongy part on the inside of the hip bone. Harvesting this graft does not affect your child’s ability to walk, run, or play sports.
In some children with cleft lip or palate, the upper jaw does not grow as much as the lower jaw. If this happens, problems with speech, chewing, and appearance may occur. Orthognathic surgery may be required to correct misalignment of the upper and lower jaws when orthodontic treatment alone cannot correct the problem. If indicated, it is typically offered to teens aged 16-19.
Plastic surgery on the nose may be recommended to improve function and/or appearance. If needed, this procedure may be performed on teens aged 16-19.