The site answers to some of the most commonly asked questions about cleft lip and palate, and provides information on the services and advice offered by the cleft lip and palate multidisciplinary team of university hospital of Poitiers. Cleft lip and palate affects the child in many ways, particularly appearance, dental arch relationships, growth of the face, and speech development. The key to successful care is the management in a multidisciplinary team adhering to a well-designed protocol.

What are cleft lip and cleft palate?

The good news is that both cleft lip and palate are treatable birth defect. Most kids who are born with it can have early neonatal reconstructive surgery to correct the cleft lip and significantly improve facial appearance.

A cleft lip is a separation of each sides of the lip. The separation often includes the bones of the upper jaw. A cleft palate is an opening in the roof of the mouth due to the non-fusion of the palate that should normally have developed before birth. Cleft lip and cleft palate can occur either on one side, or on both side. Since the lip and the palate develop separately, it is possible for the child to have a cleft lip or only a cleft palate, or else both of them One out of 500 children in France is born with a cleft lip and/or palate. We do not know why the joining up process fails in this way. Some evidence suggests there may be a combination of genetic and environmental factors.

• J.N. Mcheik et al. Réparation chirurgicale néonatale des fentes labiales : impact psychologique chez les mères. Archives de Pédiatrie 2006 ; 13 : 346-351.
• J.N. Mcheik et al. Fentes labiopalatines. Analyse épidémiologique: à propos de 60 cas. Ann. Chir. Plast. Esthét. 2000; 45: 425-9.

Can our baby be fed properly?

The baby with cleft lip and palate can profit of breast-feeding or the bottle feeding with normal soft nipple or at several speeds. Some babies with clefts have very few or no problems feeding. To make breast feeding easier, the baby is placed in a more upright comfortable position. Feeding difficulties have been reported in infants with cleft lip and/or palate. In spite of these difficulties, it is in many ways beneficial for the infant to be breastfed and for the mother to breastfeed. Neonatal feeding orientation is necessary in every case and represents an important way to achieve effective weight gain. Educational programs involving regular paediatric follow-up, multi-professional teams and parents may improve feeding of the babies with cleft lip and/or palate.

 

3. Mcheik JN et al. Growth in infants in the first two years of life after neonatal repair for unilateral cleft lip and palate. Int J Pediatr Otorhinolaryngol. 2010; 74: 465-8.

Early neonatal cleft lip repair

We are currently encouraging early neonatal cleft lip repair in the full-term baby. Lip surgery is performed according to the Millard technique. The aim is to repair the orbicularis oris muscle as soon as possible. No separation between the baby and his mother is necessary and breast- feeding is encouraged. If the cleft lip associated with cleft palate, surgery to close the gap in the palate is usually performed done at about six months old. Both operations take place with the baby asleep under general anaesthesia and involve a 2 days hospital stay.

4. J.N. Mcheik et al. Early repair for infants with cleft lip and nose. International Journal of Pediatric Otorhinolaryngology 2006; 70: 1785-90.

5. J.N. Mcheik et al. Réparation chirurgical précoce des fentes labiales. Revue de 218 enfants (263 fentes labiales) opérés. Ann Chir Plast Esthet. 2002 ; 47 : 204-9.

Will our baby’s teeth grow properly?

Painstaking attention should be paid in the case of a cleft lip and palate. The first and permanent teeth play a crucial role in the eventual success of an orthodontist’s work. The first full orthodontic assessment occurs at around 4 years of age. If the cleft affects only the lip, the teeth will probably not be affected. The teeth will, however, be affected in the labio-alveolar cleft. For some children simple orthodontic treatment involving braces to straighten the teeth can be done and no further treatment will be needed. If there is a gap in the gum, a bone graft may be used to fill it at eight years of age. However, in most cases, expansion of the maxilla is necessary at about 8 to 10 years old. In very few cases, an osteotomy to correct a misalignment of the dental arches is necessary after puberty. In the majority of cases, this surgery yields highly satisfactory results.

Will our baby have difficulty talking?

Children with a cleft palate are particularly prone to ear infections because the cleft can interfere with the functioning of the middle ear. To allow proper drainage and air circulation, the ear-nose-throat specialist on the cleft lip and palate team may recommend insertion of a small plastic ventilation tube in the eardrum (a grommet). This relatively minor operation can be done either later on or at the time of the cleft repair. Some children with cleft palate need the help of a speech pathologist. The objective is to help the child to develop normal speech as soon as possible.

How will we organize reviews with the different cleft team members?

After antenatal diagnosis or following after birth, the surgeon proposes a meeting with the parents as soon as possible. During this meeting, we detail the different methods of cleft repair. Ideally, children with cleft lip and palate are treated by a specialist “cleft team” which includes plastic paediatric surgeon, ENT surgeon as well as speech therapist and orthodontist. Care and support of the child and the family should last from birth until the child stops growing at approximately the age of 18. The surgeon introduces the parents to the team members: ENT after the sixth month and then every year, the speech therapist and the orthodontist during the first year and then on a regular basis. It is possible to repair the cleft lip of babies from other European countries with accordance of their respective policies. Health insurance will pay for all or part of the necessary care.
6. JN. Mcheik et al. Cleft lip and palate: indications for radiological postnatal explorations. Archives de pédiatrie. 2008 ; 15 : 1388-92.