Cleft lip and cleft palates occur in approximately 1:700 - 1:1,000 live births. Cleft lips are frequently diagnosed on ultrasound scanning. Sometimes a cleft palate can be detected this way. Most frequently an isolated cleft palate is detected at birth.

When can patients with cleft lip and palate be seen?
The four main cleft lip and palate centres are Auckland, Hamilton, Wellington and Christchurch. There may be outreach clinics from these centres. Parents and children are generally seen at the time of diagnosis.

Can cleft babies breast feed?
Most babies with an isolated cleft clip are able to breast feed. Babies with a partial cleft palate also can often breast feed. Babies with wide cleft palates are usually not able to breast feed. Help with feeding will be given from speech therapists and lactation consultations. Some babies can feed with a combination of breast and bottle. There are special teats available to help babies, eg Habermam and pigeon teat.

Surgery

Cleft lip and palate surgery is usually staged. Children with cleft lip and palate are usually followed up until the age of 18 in the multi-disciplinary team.

Unilateral cleft lip repair

Unilateral cleft lip repair is generally performed when the baby is 3-4 months old. Surgery takes approximately 2 hours. The hospital stay is generally 2-3 days. During this procedure the lip is repaired and the nose reshaped.

Bilateral cleft lip repair (two sided)

Bilateral cleft lips are also usually repaired at 3-4 months with 2-3 days in hospital.

Cleft palate repair

In most cases the cleft palate repair is performed at 9-12 months. Surgery generally lasts 2 hours. The local tissue of the palate is rearranged to close the gap and the speech muscles are restored to their proper place. Most children are in hospital for 3-5 days following surgery.

Will my child need grommets?
Children with cleft palate have a much higher chance of having glue ear. An ear nose and throat specialist will make an assessment to determine whether grommets would be helpful at the time of cleft palate repair.

Follow-Up

Children with cleft lip and palate are followed regularly by the multi-disciplinary cleft team. Cleft lip and palate teams consist of a plastic surgeon, a maxillofacial surgeon, orthodontist, speech therapists and also in some cases a paediatric dentist and ear nose and throat specialist. Speech will be closely monitored as the child develops. Most children develop normal or near-normal speech after surgery, however some may require further surgery to improve speech.

Orthodontics and bone grafting

At the age of approximate 8 years old children who have had repaired cleft of the front of the palate will require orthodontics to ready the adult teeth for bone grafting of the gap in the gum line (or alveolus). Bone is generally taken from the hip in an operation lasting 1½ hours. This is packed into the gap in readiness for the canine tooth to drop into this space. Further orthodontics will then be required.

Other procedures

At the age of 16-18 jaw surgery to bring the upper jaw forward is sometimes required. Reshaping of the nose (or rhinoplasty) is usually the last procedure that may be required at this age.

Links

Cleft Lip and Palate Support Group www.cleft.org.nz

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