Infants born with clefts (lip and/or palate) are special babies and will require special care as a result. Babies can be born with cleft lip without having a cleft in their palate (roof of mouth), a cleft palate without a cleft lip, or both cleft lip and palate.
Repairing a cleft lip is a procedure that normally takes place between the ages of 3 and 6 months. Some conditioning of the tissues is often helpful in the months prior to surgery. This can be done with specialized appliances (nasoalveolar molding—NAM) or sometimes simply with special tape. The surgery often takes between approximately 90-120 minutes and the patient is monitored in the hospital overnight prior to being cleared to return home. The tape placed over the repair will peel and fall off during the first week after surgery. The remaining sutures are of a type that dissolve or “fall out” on their own. Follow up appointments with Dr. Khan ensure that proper steps are being taken to decrease the size and visibility of the scar from the repair.
Many, if not all, of these infants benefit from specialty feeding bottles to help them grow and develop. Cleft palates present in a wide spectrum of severity. Some clefts have the overlying mucosa intact such that there is little if any evidence of a cleft on the surface when looking in the mouth. Traditional clefts can be only in the soft palate, both the hard and soft palate, and some involve soft palate, hard palate and the alveolus (ridge where there are teeth). The surgical repair often takes place between the ages of 12 and 18 months of age – around the time that the child’s speech has just started developing.
The aim of the repair is to reconstruct a nasal floor, re-orient the muscle that helps with speech and function, and construct an oral (mouth) lining as well. These three layers, when properly healed, will separate the nose from the mouth and allow for proper speech.
This repair takes approximately two hours of operating time. The patient is monitored overnight to ensure they are drinking again on their own before being allowed to return home. A soft diet (no hard foods) is necessary for several weeks following the surgery.
Children that are born both with a cleft lip and cleft palate may also have an alveolar cleft. This cleft is a gap in the bone that holds the dentition (teeth).
Timing for repair of this cleft depends upon tooth development and should take place when the canine is still developing and prior to its descent and eruption into the mouth. This is often around 8-12 years of age.
The alveolar bone graft:
- adds continuity of the gum ridge
- adds support to the base of the nose
- gives a smile back to the child
- aids in eating and digestion
- aids in proper facial growth
- gives new bone for the roots of the incoming permanent teeth to grow into
This repair also closes off the final “hole” or fistula between the mouth and the nose.
The procedure takes around 90 minutes to complete and the patient is watched overnight to monitor pain control. The most tender site after surgery is usually the donor site for bone (if this is the option chosen), which is most often the hip.
Cleft lip patients who’s deformity involved their nose will most likely have a nose defect as an adult. They may or may not want to have this addressed surgically once they have stopped growing.
Dr. Khan performs rhinoplasty procedures regularly. However a rhinoplasty on a cleft patient takes significant skill and attention to detail. These procedures are not just cosmetic but reconstructive. Due to his extra training in cleft and craniofaciual surgery Dr. Khan has the ability to help such patients with their cleft nasal deformity.
One of the aims of the cleft palate repair is to re-orient the muscle that helps with speech and function.
Patients with previous cleft palate repair may still have persistent speech issues.
Dr. Khan has significant expertise in:
- Cleft palate re-repair (An operation to relocate the muscles of the soft palate to allow it to move more effectively or lengthen the palate)
- Specific speech surgeries such as:
- Pharyngeal flap (An operation to fix the soft palate to the back of the throat and to create a new valve system that can be controlled by the muscles of the throat)
- Sphincter Pharyngoplasty (An operation to narrow the space behind the soft palate so that the soft palate has a smaller gap to close)
If your child suffers from speech issues, make an appointment with Dr. Khan for an evaluation.