Oro-maxillofacial and Plastic Surgery

mri

Knowledge creates healing

Cleft Lip and Palate

• Nasoalveolar Molding (NAM) – further Information about presurgical treatment

In Germany, cleft lips and palates occur  – in various forms and degrees of severity – statistically once in about every 500 new born children; with a proportion of 15 % they are one of the most frequent kind of malformations. The cause for this is still not entirely clear, but several factors seem to play a role. With every fifth child genetic causes play a part, this can go back several generations.

 

lkg_obenFor parents who themselves were affected, the statistical risk of giving birth to a child with a cleft lip or palate is about 4 – 5 percent; the same applies to healthy parents who already have a child with a cleft palate. If the first born child is a cleft child, the statistical risk for further children increases to 13 – 14 percent. Some mothers worry that they may have done something wrong during pregnancy, but this guilt is completely unfounded! Whether there is a genetic pre-disposition and how high the risk that further children will also have a cleft palate can be more exactly determined at a genetic advisory center; here, rare combinations with other deformities are also analyzed. During the child’s development in the uterus, between the 5. and 9. week, there is either a missed union or tearing of tissue, from which later on nose, lips and upper jaw will develop. Depending on when this developmental dysfuntion occurs and how severe it is, different cleft forms develop (cleft lip on one or both sides, cleft lip-jaw, cleft lip, jaw and palate, and/or complete cleft palates and isolated clefts of the soft palate) with different degrees of severity.  

Although temporomandibular surgery has laid the foundations for the success of the treatment, other medical specialist areas are also significantly involved in the care of your child, namely the orthodontist, the pediatrician, the ENT specialist, the speech therapist and the dentist. As many of the therapy stages are intertwined, and as your child’s appearance is constantly changing due to growth, the final result can really only be judged after puberty.

For some parents it is hard to understand why some operations can only be carried out at a later date, and others relatively early, or why not all parts of a cleft lip and palate can be closed in a single operation as early as possible. The reason for this is that operations carried out too early on certain parts of the cleft lip and palate, especially on the hard palate, can lead to dysfunctional growth, whereas operations carried out too late, for example to the soft palate, can cause delayed or faulty speech development. Decades of experience in cleft palate surgery enable the best possible timing for surgery for every stage of the cleft palate, whereby there are often differences from clinic to clinic. Most big hospitals in Germany however do not only operate according to very similar timetables, but they also use the same successful techniques. This is also true for accompanying treatment from other medical specialist areas, which is of great importance during certain development phases of your child.

The first step is usually the production of the above mentioned palate plate, which is placed in your child’s mouth during the first days of its life. It not only facilitates drinking,  but also enables the forming of the dental bow or lessens the cleft, due to systematic grinding of the undersurface of the plate. Your child will need a new plate every 6 to 8 weeks, i.e. it will ususally be renewed once before the first operation. If your child does not have a cleft  of the hard palate, that is to say just a lip-jaw or an isolated cleft of the soft palate, this form of plate treatment is not necessary. 

We are happy to arrange a meeting with breastfeeding and lactation adviser Elke Schubert if so required.

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Figure: complete unilateral cleft lip and palate before and after combined primary lip and soft palate repair

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Figure: incomplete unilateral isolated cleft lip before and after primary lip repair