Cleft Lip & Palate

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 back to as normal a childhood as possible. Dr. Chariker is codirector 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 also sees patients from southern Indiana as well.

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, making the repair extremely important to 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. Children who cannot communicate have difficulty in the job force and have difficulty integrating into their world socially.

The deformity occurs during fetal development at 6-7 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 are prenatal vitamin deficiency and environmental factors that lead to errors in the genetic code known as gene mutations.

Treatment of Cleft Lip

The sequence of repair starts with the lip. This is started at one to three months of age. By repairing the lip muscle, recontouring of the underlying bone, gum and palate is initiated. This helps align the underlying structures, closes the gaps of the cleft and sets the stage for the palate repair, which is performed at six to twelve months of age. This early sequence of repair often avoids the need for preoperative treatment with tape, straps or orthodontic gum splints.

The palate not only to 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 or VPI for short.

 

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.