Dr. Randolph Robinson offers cleft palate surgery and cleft lip surgery in Denver, CO. Please keep reading to learn more about oral surgery, associated risks, and expected outcomes of this very successful maxillofacial surgical procedure:
A cleft lip and/or cleft palate can be a most devastating occurrence for the mother, father, and child. But it does not have to be. Well-established procedures and therapies, ranging from surgical interventions, orthodontics, to speech and hearing therapy can restore esthetics and function. A team approach can add insight and recommendations at various stages.
Cleft lip and palate formations occur in one out of 600 births in the United States; one in 700 worldwide. And in some developing countries the incidence may be as high as one out of 400.
The defect occurs about the sixth week in embryonic development. As the various developmental components of the face begin to fuse, a non-union or breakdown occurs along the seams. As a result, the cleft forms according to the degree of non-union.
If you’d like to learn more about your surgical options to correct a cleft palate or cleft lip, contact Robinson Cosmetic Surgery in Lone Tree, CO. We can schedule an appointment for you to talk to our wonderful maxillofacial surgeon, Dr. Randy Robinson.
Understanding Birth Defects
The National Birth Defects Prevention Study is the largest type study of its kind in the US, following 35,000 women. Recent possible contributory findings for cleft lip and or palate deformities include: mothers who smoke or are near others who do (causing lower blood oxygen levels, or hypoxia, for the fetus), the presence of diabetes, hypertension, use of pain killers, and genital tract infections during pregnancy.
Currently (CDC, 2012), one in 33 babies in the US are born with some type of defect. It is important to note, however, that 70% of all defects’ causes remain unknown.
Cleft lip and palate defects occur in a variety of combinations from complete lip/palate, partial lip/complete palate, or complete lip/partial palate. Cleft deformities are more common in males. More often, 60 percent of the time, they are located on the left side of the face.
About Bilateral Clefts
Occasionally, however, the clefts may be both on the right and the left sides. Bilateral clefts can vary in their presentations and severity also.
A complete cleft lip and palate begins in the upper lip, connecting the mouth to the nose. The bone around the teeth is called the alveolus and is also clefted. There can be missing, deformed, or extra teeth in the area. The cleft then may extend onto the hard palate. That means the mouth and the nasal passage are connected.
And finally, the soft palate may be divided. When it does, this division affects speech. Because of the open passages in cleft palates, children with such deformities are prone to have ear infections. Subsequent hearing loss might occur if the infections are not treated.
Feeding and nutrition are usually of immediate concern, and education and moral support are essential. Various forms of bottles with modified nipples, oral appliances, and techniques for breast feeding infants with clefts are available and offer an adequate means for nutrition and satisfaction both to the infants and their mothers. Feeding specialists in hospital settings are able to address these concerns at the time of birth and reinforcement and support from consultants is available.
Life-long care by specialists is also available to the families and cleft patients. These care-givers include hearing specialists, called audiologists, speech pathologists, speech therapists, ear, nose, and throat specialists, plastic, oral and maxillofacial surgeons, orthodontists, pediatricians, pediatric dentists, social workers, psychologists, psychiatrists, and geneticists.
To provide overall planning, the child will be examined at various times by all these people in a team setting. At times, the child may be examined by individuals, depending on the age and needs. Usually, the primary surgeon will be the coordinating team member.
The surgical treatment for cleft lip and palate has both standard and variable aspects, depending on the needs of the patient. Below is a typical schedule for treatment:
- Closure of the lip: 3 months
- Closure of the palate: 12 months
- Ear tubes placed: as needed
- Pediatric dentist appointment: 3 years
- Speech therapy: 5 years
- Lip and/or palate revision: 5 years
- Orthodontist evaluation: 6 years
- Initial orthodontic treatment: 9 years
- Bone graft to cleft: 9 1/2 years
- Facial skeletal surgery: 14-19 years
- Nasal revision: 14-19 years
- Dental reconstruction: 14-21 years
When the child is five to seven years old, orthodontic needs should be evaluated. Bone grafting of the cleft in the tooth-bearing area, called the alveolus, is,performed between ages nine and eleven, preceded by expansion of the palate to correct any cross-bite, intercepting the eruption of the upper canine tooth into the cleft.
Final orthodontic treatment is completed during mid-adolescence in conjunction with surgery, if necessary, to correct any disproportionate facial growth. This surgery may involve moving the midface forward, up, and/or down. This type of facial/jaw surgery is known as orthognathic surgery and is recommended if the face does not grow properly.
Cleft Palate and Cleft Lip Surgery Procedure Details
The ordinary repair of the lip is usually performed by the age of 3 months. At this age the baby is large enough to undergo the surgery with minimal complications. The “Rule of Tens” is: 10 weeks of age, 10 pounds of weight, and a hemoglobin level of 10mg/dl (blood count).
First, a breathing tube is placed through the mouth to breathe for the baby during the general anesthesia. The surgery lasts 1 1/2 to 2 hours, including the preparation time.
A variety of methods is available to surgically close the lip. The main goals of all methods are to approximate the muscles, align the vermillion (the red part of the lips where lipstick is applied), establish the symmetry of the nose, and create the philtrum (cupid’s bow). Sutures are placed on the skin surface, in the lip muscles, and in the mucosa in the mouth. Only the sutures on the skin need to be removed, the others will dissolve. The most common repair is called the Millard Rotational Advancement Technique and accomplishes all these goals while allowing the surgeon to tailor the repair for the individual child.
The baby can resume feeding either from the breast or the bottle soon after surgery. Because of the baby’s small size, he or she will need to stay in the hospital overnight to make sure feeding is adequate.
The lip will be swollen and tender. A small amount of oozing of blood will be present along the incision line. Rarely is there any bruising but the incision will be red for several months and then fade to a white line. Children tend to retain the redness longer than adults. Sutures are removed in five days, and the incision is taped with a skin glue to keep it from spreading apart. Typically, some residual asymmetry may last for the first six months. Revision will usually be necessary in the future.
The complications for lip repair include: severe asymmetry, eye socket deformities, scarring, infection, bleeding, and stitch abscesses.
- Do not feed the baby for four hours prior to surgery.
- Make arrangements for yourself to stay overnight at the hospital.
- Make sure all questions are answered prior to surgery.
- You may resume feeding either by bottle or by breast the day of surgery. A special feeding nipple and/or technique may continue to be necessary.
- If no tape or bandage is placed over the surgical site, it should be cleansed twice each day with a 50:50 mixture of hydrogen peroxide and water using a cotton-tipped applicator.
- After each cleaning, antibiotic ointment (e.g.Bacitracin) should be applied to the surgical site.
- Sutures will be removed five to seven days after surgery.
- Call if there is difficulty breathing, bleeding, swelling, or signs of increasing pain.
The emotional and psychological pressures of having a facial difference can be great. Children’s faces are closely connected to their identity and their ability to relate with the world around them. Some must deal with their own resentment and rejection. But most reach a point of resolution and acceptance.
Love and acceptance are very important. Many times, parents may go through a period of guilt or blame, or discord between themselves. Trying to understand why these experiences happen sometimes defies explanation. The counsel from pastors, licensed counselors, psychologists, support groups, books and close friends can help the parents cope with this difficult circumstance.
Learn More About Cleft Palate and Cleft Lip Surgery Options in Denver
Randolph C. Robinson, MD, DDS, FAACS, is highly trained and experienced in providing patients the highest level of cleft palate and cleft lip surgical care. Call Dr. Robinson’s office to schedule an appointment. Please keep in mind that an appointment may require a doctor’s orders and you should consult your insurance provider for coverage details.