Cleft Lip and Palate Timeline
No parent wants to learn that their child is going to be born with challenges, but it is important to know that we have specialized teams in place close to home to help meet those challenges for families in New Orleans, Louisiana, and the Gulf Coast.
If a prenatal screening has revealed that your child will be born with cleft lip or palate, here is what to expect.
Pre- and Post-Natal Care
A child born with a cleft lip with or without cleft palate will need to be seen by an ACPA-certified plastic surgeon as early as possible, as early as 2 to 3 days of age.
This is absolutely critical for your child’s future. A newborn still retains maternal estrogen that makes his or her bones more malleable—and therefore more responsive to care. The sooner a surgeon sees your child, the better the results of pre-surgical molding are likely to be.
The first step is choosing a team, educating yourself, and preparing to feed your child once your family is home from the hospital. Because your child will require multiple surgeries, it is very important to be comfortable with the team and your surgeon. Any hospital should be able to recommend a team, but the ACPA team finder is an excellent resource as well.
Surgery to Repair Cleft Lip
If your child has a cleft lip as well as a cleft palate, your surgeon will recommend pre-surgical measures to reduce scarring. Surgery to repair cleft lip is usually performed at 3 to 4 months of age, depending on the nature and severity of the cleft. Click here to read more about cleft lip.
Surgery to Repair Cleft Palate at 10 to 12 Months
Your surgeon is likely to recommend surgery to repair your child’s palate at 10 to 12 months of age. During the repair, the team’s ENT will insert pressure equalization (PE) tubes via the ear canal. (The muscles of the soft palate also control the drainage of the inner ear.)
Not all children who have cleft palate will have problems with their hearing, but this five-minute additional procedure is important in order to ensure the proper growth and development of the inner ear.
Your team is gathered to support the healthy growth of your child, and you will see members of this team at least once a year until your child has finished growing. While the surgical results are likely to be stable over time, follow-up care allows us to monitor the success of those results in the context of your child’s growth.
Regular dental checkups and cleanings should also be observed.
Your child will most likely require ongoing speech therapy, and it is best to start early, even before they start speaking and most certainly by their second birthday. There are programs available through most public school systems and supplementary public programs (even if the family does not qualify for Medicaid).
Five Years of Age
At five years of age we generally reevaluate the results of surgery to ensure that the results are stable as your child heads off to school. Occasionally, corrective speech surgery may be required, and in the case of children born with combined cleft lip and palate, any revisions would be performed at this time.
7 to 8 Years of Age
As every child is different, so is every cleft unique. Some children will require an orthodontist—and braces—and others will not. Malpositioned teeth are common in kids born with cleft palate. Often, their teeth do not fit well together. With that said, the decision to wear braces is a personal one, of course, and will depend on the child, the family, and the severity of any dental issues.
9 to 10 Years of Age
In the case of a cleft of the primary—or bony—palate, the child may need additional surgery to add bone to the gum ridge. This is known as an “alveolar bone graft.” We perform this surgery as the child begins to lose his or her baby teeth, in order to ensure that the permanent teeth develop properly. An overnight stay in the hospital is required, as your child will be placed under general anesthesia during the procedure.
Adolescence and Beyond
Once your child has his or her permanent teeth, any additional orthodontic treatment may begin. Later in their teen years, if speech therapy has proven insufficient, your surgeon may recommend (and the family and child decide upon) surgical intervention in the form of corrective jaw surgery. And in children who have a deviated septum, completion rhinoplasty is recommended after graduation from high school.