Cleft Lip & Palate
Note, if your child has a cleft lip and/or palate and you’re seeking treatment, you should make an appointment in the Cleft Palate Clinic at the Alberta Children’s Hospital. Dr. Robertson attends this multi-disciplinary clinic and most cleft care is coordinated through that clinic. You can reach that office at 403-955-7694.
During early pregnancy, separate areas of the face develop individually and then join together, including the left and right sides of the roof of the mouth and lips. However, if some parts do not join properly, sections don’t meet and the result is a cleft. If the separation occurs in the upper lip, the child is said to have a cleft lip.
A completely formed lip is important not only for a normal facial appearance but also for sucking and to form certain sounds made during speech. A cleft lip is a condition that creates an opening in the upper lip between the mouth and nose. It looks as though there is a split in the lip. It can range from a slight notch in the colored portion of the lip to complete separation in one or both sides of the lip extending up and into the nose. A cleft on one side is called a unilateral cleft. If a cleft occurs on both sides, it is called a bilateral cleft.
The cleft can involve just the palate, just the lip, or the lip and the palate. The cleft can also occur just on one side or on both sides. A cleft of some type occurs in about one out of every 700 babies.
Sometimes a baby with a cleft palate may have a small chin and a few babies with this combination may have difficulties with breathing easily. This condition is called Pierre Robin sequence and sometimes requires management at earlier ages.
Children born with either or both of these conditions usually need the skills of several professionals to manage the problems associated with the defect such as feeding, speech, hearing and psychological development. In most cases, surgery is required for repair. When surgery is done by an experienced, qualified oral and maxillofacial surgeon such as Dr. Robertson, the results can be quite positive.
Cleft Lip Repair
Cleft lip surgery is usually performed when the child is just a few months old. The goal of surgery is to close the separation, restore muscle function, and provide a normal shape to the mouth. The nostril deformity may be improved as a result of the procedure or may require a subsequent surgery.
Cleft Palate Repair
A cleft palate is initially treated with surgery safely when the child is between 7 to 18 months old. This depends upon the individual child and his/her own situation. For example, if the child has other associated health problems, it is likely that the surgery will be delayed.
The major goals of surgery are to:
- Close the gap or hole between the roof of the mouth and the nose.
- Reconnect the muscles that make the palate work.
- Make the repaired palate long enough so that the palate can perform its function properly.
There are many different techniques that surgeons will use to accomplish these goals. The choice of techniques may vary between surgeons and should be discussed between the parents and the surgeon prior to surgery.
Cleft Alveolar Bone Grafting
If the cleft involves the upper jaw (where the teeth are), then typically a bone graft is required to fill in the gum cleft. This is usually done between ages 6-9, but sometimes needs to be delayed until a little later. This is done with the patient competely off to sleep (general anesthesia), and bone is typically taken from the hip to reconstruct the bony defect in the upper jaw. This procedure is designed to close any remaining gaps between the mouth and the nose, and also provide sufficient bone for eruption of adult teeth in the area, and possibly for replacement of teeth if any are missing.
Cleft Orthognathic Surgery
It’s quite common for a cleft in the upper jaw to result in deficient forward growth of this jaw, resulting in an underbite (or class III malocclusion). Throughout childhood, growth modification can be attempted by a qualified orthodontist to make up for this, however if the discrepancy is too large by skeletal maturity, then often jaw surgery will be recommended to surgically correct the position of the upper jaw. This is done both for proper function and facial esthetics, and is typically done between ages 16-20 but can be done later in life as well.