A cleft lip and a cleft palate are two related conditions, where the tissue growing from either side of the face in a fetus fails to join together. Affecting 1 in 1,000 babies every year, the cleft is the fourth most common birth defect in the United States. It occurs more often in children of Asian descent, though it’s not clear why. In addition, twice as many boys as girls have a cleft lip, either with or without a cleft palate; and twice as many girls as boys have a cleft palate without a cleft lip. Because the lip and the palate develop separately, it’s possible to have any combination of defects, with the most common being both a cleft lip and palate.
At PNW Surgery in Portland, Oregon, Dr. Leo Urbinelli, a leader in craniofacial surgery, puts his years of specialized surgical experience to work repairing cleft palates and many other craniofacial disorders. As having a child with a severe facial deformity such as a cleft palate or cleft lip can be initially overwhelming to parents, he wants them to understand more about the issue, including its potential causes and solutions.
Cleft lips and palates occur during specific periods during pregnancy. The lip develops between the fourth and seventh weeks. Body tissue and special cells from each side of the head grow toward the center of the face and join together to make the facial features. A cleft lip happens if the tissue destined for the lip doesn’t join completely before birth, resulting in an opening in the upper lip, anywhere from a small slit to a gap that extends into the nose.
The palate (roof of the mouth) forms between the sixth and ninth weeks. A cleft palate occurs when the tissue from both sides doesn’t join completely to form the roof. The baby might only have part of the palate open, or both the front and back.
In most cases, doctors don’t know the causes of cleft lip and cleft palate, which means the defects can’t be prevented. They’re probably caused by a combination of genetic and environmental factors. In terms of genetics, a child is at higher risk if a parent or other close relative has had the problem.
As for environmental factors, a child is at higher risk if the mother smokes. In addition, risk increases if the mother took certain medications during pregnancy, such as anticonvulsants; acne medications including Accutane®; or methotrexate, a drug used for treating cancer, arthritis, and psoriasis.
Dr. Urbinelli treats cleft lips and palates with plastic surgery to reshape and rebuild the separated tissues. A cleft lip needs one or two surgeries, depending on the completeness and width of the cleft. He usually performs the first surgery by the time the baby reaches 3 months old, and the second, if needed, when the baby is 6 months old.
Cleft palate repair involves creating a working palate to aid chewing and speech, which also helps reduce the chances fluid will develop in the middle ears. Children with cleft palates usually need special tubes placed in their eardrums to help with fluid drainage. This is often done at the time of palate repair, which takes place at 12 months.
The effects of the repairs are often quite dramatic; not only are the child’s lips and mouth restored functionally, but their faces now look like any other child’s.
However, about 30-40% of children with a cleft palate need additional surgeries to help improve their speech. The surgery is usually performed around 5 years old.
Children with a cleft that involves the gum line may also need a bone graft when they’re about 6-10 to stabilize the upper jaw and allow it to support permanent teeth. Additional surgeries may be required to improve appearance, close openings between the mouth and nose, and help with breathing.
Repair surgery for a cleft lip or palate is straightforward and can dramatically improve your child’s life. To learn more, give PNW Plastic Surgery a call at 503-208-2348 to schedule a consultation with Dr. Urbinelli, or book online with us today.