A cleft Is a gap or opening in the upper lip and / or root of the mouth and is present from birth. The gap occurs because parts of the baby’s face did not join together properly during development in the womb. The opening may be on one side, both sides, or in the middle. Sometimes the opening can connect with an opening in the gums and the lip ( cleft lip and palate) Cleft palates are the most common facial birth defect in the UK that’s around 1,200 babies each year in the UK!
A cleft palate can result in feeding problems, speech problems, hearing problems and frequent ear infections.
We don’t know why a baby develops a cleft though some studies say clefts may be attributed to genetic factors. There are some environment risk factors that can be associated with a baby being born with a cleft palate which include smoking or drinking alcohol during pregnancy or taking drugs, diabetes, obesity, certain medications, being exposed to some chemicals during pregnancy or not getting the right amount of prenatal nutrients. Most of the time a cleft is caused by genetic and environmental factors coming together in a way which cannot be predicted or prevented. Cleft palate can also develop as part of a syndrome and there are around 100 syndromes that feature cleft palate.
Cleft palate has been associated with adverse long term health effects such as elevated risks for death, intellectual disability, anxiety disorders, autism spectrum disorders, severe learning disabilities, cerebral palsy, epilepsy and musculoskeletal disorders when compared to the unaffected population. Cleft lip alone is not associated with any long term health problems.
Surgery is needed to close the gap left by the cleft. This will usually happen when the child is under a year old.
Cleft palate surgery is called palatoplasty and is carried out under general anaesthesia. The objectives of this procedure are:
1) to close the opening between the nose and mouth
2) help create a palate that works well for speech
3) prevent food and liquid from leaking out of the nose
Therefore a surgeon must
1) close the cleft in layers,
2) rearrange and repair
Every cleft is unique just like every child so treatment may differ slightly for each patient. After surgery the roof of the child’s mouth is still healing and should be protected from injury for about three weeks. There may be less feeling in the area for a while after the surgery which means the child could injure the roof of the mouth without you or them knowing it so it is important to put hard objects away out of the child’s reach while the palate is healing.
Further surgery may be needed at various stages of childhood and adolescence and if there are issues other therapies may be needed also such as speech therapy, help with hearing or orthodontic treatment. However there are few long term effects of cleft palate and children grow up to lead normal lives.
Mr Ferrando’s area of expertise with regards to Cleft Lip and Cleft Palate Surgery is remedial surgery on adults that have had cleft lip or cleft palate surgery in childhood but need further corrective surgery.