This category of deformities involves the upper lip and palate (roof of the mouth). These deformities may involve all or part of the lip and/or palate. The cleft itself results from the failure of all or part of the skin, muscle and bone to develop and fuse properly. The defect may be on one side or both, which classifies the defect as unilateral or bilateral. The defect may be isolated to the lip, palate, or involve both structures. The incidence is about 5,000 cases per year in the United States. The management of this category of congenital deformities requires a team of physicians and therapists to manage all of the associated problems and assist in mainstreaming these children to live a normal childhood. Dr. Chariker is co-director of a local team in Louisville called the Commission for Children With Special Health Care Needs. The commission evaluates and treats children from all around the state of Kentucky. Dr. Chariker's practice sees patients from southern Indiana as well.
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Cleft Lip & Palate
Procedure Information
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Manifestations
The functional issues with a cleft lip includes problems with feeding, speech, drooling, and oral hygiene. The psychosocial repercussions are enormous, and the result is a child who is a social recluse. Hence, this repair is extremely important for the success of the child. The manifestations of the palate are also devastating. The functional problems associated with a cleft palate include chronic otitis media, feeding difficulties, chronic sinusitis, speech disorders, and halitosis (chronic bad breath). Children who cannot communicate have difficulty in the job force and have difficulty integrating into their world socially.
Etiology
The deformity occurs during fetal development at six to seven weeks gestation. An isolated gene deformity has not been identified in the majority of cases except Van der Woude Syndrome. The reasons most commonly attributed to this abnormality are prenatal vitamin deficiency and environmental factors that lead to gene mutations.
Treatment of Cleft Lip
The sequence of repair starts with the lip. This is started at one to three months of age. Repairing the lip muscle initiates the recontouring of the underlying bone, gum, and palate. This first procedure helps align the underlying structures, closes the gaps of the cleft, and sets the stage for the palate repair. This early sequence of repair often avoids the need for preoperative treatment with tape, straps, or orthodontic gum splints.
Treatment of Cleft Palate
The palate not only prevents flow of oral secretions and food into the nose, but also provides a critical portion of the valve structure that controls air flow into the nose. The muscles that provide this function are in the soft palate. If they fail to function properly, the result is too much nasal airflow. This is called hypernasality or velopharyngeal insufficiency (VPI).
The structures required to repair the palate are usually located on the edges of the cleft. The timing of the repair is between six to twelve months of age. If bone is missing in the cleft, it is not replaced except in the gum area. The muscles are reconstructed in the soft palate. If the muscle is underdeveloped, a secondary procedure may be required if the child demonstrates enough hypernasality to distort the speech.