Cleft Lip and Palate
Cleft lip and palate is one of the most common congenital craniofacial disorders. 1 in about every 1,000 babies in the United States will be born with a cleft lip, cleft palate or both. Patients born with a cleft deformity might experience problems with feeding, speech, and hearing, as well psychological stresses and issues with social well being secondary to their aesthetic deformity. Dr. Rodman’s combined training in ear, nose and throat as well as craniofacial surgery enables her to address many of the needs of patients born with clefts.
Some of the surgeries a cleft patient may need:
Initial cleft repair:
A cleft lip is usually repaired around 3 months of age and involves at least one night stay in the hospital to ensure the baby is able to feed with a special feeder.
A cleft palate is usually repaired around one year of age and the baby will usually stay several nights in the hospital after this procedure to ensure pain is controlled and the baby is able to eat and drink.
Ear tubes are needed in most patients with a cleft palate. The muscles of the palate help open the Eustachian tube, which helps regulate pressure in the ears. In patients with a cleft palate, 9 times out of 10 this tube does not work and fluid can build up in the middle ear. A small set of tubes placed in the eardrum can serve as a replacement for the Eustachian tube and help cleft patients with hearing.
Revision Cleft Repair:
The initial cleft repair may not have healed in an optimal way, and the parents or patient may desire a revision. Dr. Rodman generally recommends doing this right before the patient starts elementary school. At this age the patient is generally old enough to cooperate with post operative instructions, and the improvements are made before the patient begins socializing with new classmates. Older children and adults who wish to have a revision may do so at any time.
There are many options in cleft lip revision. In some cases, the entire closure may need to be redone. In other cases, the scar may need partial excision or laser resurfacing. At your consultation, Dr. Rodman will listen to your concerns and work with the patient and family to come up with a solution that serves everyone’s needs.
Alveolar bone graft:
Patients who have a cleft in their gums may need a bone graft to help bridge the gap in the gums and help the teeth to grow in that area. In this surgery, some bone marrow is taken from the patient’s hip bone and placed into the gap to help new bone growth. The timing of this is different for each child, it is done when the patient begins to lose their baby teeth, but before the permanent teeth come in, generally between the ages of 7-10 years old. Children need to stay at least one night in the hospital after this surgery and need about two weeks to recover afterwards. They will need to follow a soft diet and may have some soreness in the hip as they try to get back to activity.
Patients born with a cleft lip will nearly always have a nasal deformity. At the initial cleft lip repair, Dr. Rodman will perform what is called a primary rhinoplasty, which will help improve the appearance of the nose right away. Still, many patients will need more surgery to the nose later in life. Most patients will need surgery to the inside of the nose to help improve breathing and surgery on the outside to help the shape and symmetry of the nostrils. In general, nose surgery, or “definitive rhinoplasty” can be done once the patient has stopped growing, usually between age 16-19 years old.
In some patients born with a cleft palate, problems with speech may occur. Dr Rodman works with several speech therapists to help patients with speaking and articulation. In the case where a speech therapist has done all he or she can, and there is still a problem, surgery may be the next step. The problem is generally a gap at the back of the throat, and the repaired palate is not making contact with the back of the throat. This contact is needed to make certain sounds and to prevent food from coming out the nose when we swallow. There are several options to correct this, and Dr Rodman will help determine which is the best option by looking with a camera at the area.
Dr. Rodman is available to see cleft patients of all ages with all different needs.
Head Shape Anomaly