Overview of Cleft Lip and Palate Center
The Cleft Lip and Palate Center brings together several different specialists to provide comprehensive inpatient and outpatient services at Children's Hospital of Wisconsin. We care for patients with cleft lip and palate disorders from birth into adulthood.
Prenatal screening by ultrasound may detect cleft lips with or without cleft palates. In these cases, our team is available for consultation. Often, becoming informed of the issues children with cleft lip and palate disorders face helps prepare parents to care for the special needs their child will have after birth, including breathing and feeding. This early meeting includes a nurse clinician and plastic surgeon. Parent's questions are answered and preparations, when necessary, are begun.
Most of the time cleft lips and/or palates are discovered at birth. Parents should remember that clefts do not hurt and their baby does not know he or she has a cleft. The two most important issues are to ensure the baby's airway is open and he or she can breathe and eat easily. Babies with cleft palates are not able to suck efficiently and may require the help of special bottles and feeding techniques. Our nurse clinician provides instruction on feeding a child with a cleft and is available to address concerns and questions. During this time period, growth and development is followed closely through the Craniofacial/Plastic Surgery Clinics at Children's Hospital as well as by the child's pediatrician. A third important issue is to consider presurgical alveolar molding therapy. This technique improves the appearance of the surgical scar and has other advantages, but must be done early to be most effective.
In some cases, the cleft is of the palate alone and is associated with a small lower jaw. Sometimes this is referred to as the Pierre Robin sequence, and in severe forms can cause blockage of the airway by the tongue, which is positioned too far back in the throat. This requires careful evaluation by the cleft team, and in some cases requires emergency surgery. Occasionally, clefts of the lip and palate can be associated with other problems in the form of a syndrome, though these are far less common than uncomplicated, unassociated cleft lips and palates.
Infancy (the first year)
Most babies will need surgery to repair the cleft(s). Usually, a cleft lip is repaired between 3 and 6 months of age. This follows a period of two to three months of alveolar molding therapy in many cases. At about 1 year of age, the cleft palate is repaired. Each operation usually requires a short hospital stay. These operations are performed by a pediatric plastic surgeon. The full-time plastic surgeons at Children's Hospital have years of experience and manage one of the largest cleft practices in the Midwest. They also contribute to physician training through their affiliation with The Medical College of Wisconsin.
Childhood and beyond
Care of children with cleft lip and palate is more than a series of operations in childhood. While every child is different, many need additional evaluation and treatment. Care is customized to each child and usually begins with a half-day evaluation around the age of 18-24 months by the full Cleft Lip and Palate Clinic. This team includes:
- Speech-language pathology - Babies born with a cleft lip alone often develop normal speech, but babies with cleft palate can have speech problems if they do not get proper speech therapy. Some children need only speech and language therapy, while others also may need a prosthetic appliance and/or surgery to correct their speech problems.
- Otolaryngologist (Ear, Nose and Throat) - Infants with cleft palate have frequent ear infections or fluid behind the eardrum. Most need to have ear tubes placed by an ENT specialist during the first year. In addition, ENT specialists evaluate the child's airway.
- Audiology - Good hearing is needed for good speech. Most babies born with a cleft lip alone have normal hearing. Children with cleft palate may develop hearing problems, however treatments are available.
- Dentistry - A pediatric dentist and/or an orthodontist with extensive experience working with clefts will examine the position and alignment of the child's teeth, which can be affected by the cleft, and offer treatment as needed. A prosthodontist works with children who may not be able to have surgery to provide an appliance that can help to improve their speech.
- Genetics - A genetic counselor can review the child's medical and family history and counsel the family on the chances of having another baby with a cleft, as well as the chances of the baby having children with clefts. In addition, these professionals can detect other rare traits that may be present in some cases.
Children generally meet with the Cleft Lip and Palate team once a year. Some children will see one or a few of the specialists more or less often as needed. The team approach assures complete care, and early intervention is the key to the best results.