By Jordan Steinberg, MD, PhD, FACS, FAAP
Surgical Director, Craniofacial Program
Cleft lip and palate are among the most common facial anomalies that we treat at the Nicklaus Children’s Craniofacial Program. For families of those born with either a cleft lip, cleft palate or both, we can identify and treat these conditions much earlier and often with fewer surgeries than in the past, thanks to developments in ultrasound technology and treatment innovations.
Cleft lip and palate occurs when a baby’s lip or mouth does not form properly during pregnancy. These facial birth defects result in a gap in the lip or palate of the newborn. A baby can have a cleft lip, cleft palate or both.
If your baby is born or identified before birth with a cleft lip and/or palate, this can certainly be a stressful time. According to the American Academy of Pediatrics, the two conditions together make up some of the most common birth anomalies, as one out of every 700 babies is born with a cleft lip, cleft palate or both. It’s certainly one of the conditions that we see the most at the Nicklaus Children’s Craniofacial Center.
Here’s what you need to know about this common condition.
Diagnosing Cleft Lip and Palate
In the past, parents typically would not know that their baby had a cleft lip or palate (or both) until after the child was born. Due to advances in ultrasound technologies, it is now common for the conditions to be identified before the baby is born through a routine prenatal exam.
At Nicklaus Children’s Hospital, parents who are expecting a child with a cleft lip and/or palate are referred to our Prenatal Clinic for Craniofacial Abnormalities. This is a tremendous resource that helps parents create a treatment plan and prepare for what to expect before their baby is even born.
At the Prenatal Clinic, parents will meet with a team of nurses, plastic and reconstructive surgeons and geneticists about how the condition will be treated after their child’s birth. They’ll receive education and learn what to expect in the months ahead. Most of the parents we work with value how much this prepares them mentally and emotionally before the birth of their child.
Treating the Condition
The Prenatal Clinic is valuable for another important reason: According to the Centers for Disease Control, outcomes are best when a child with cleft lip and/or palate begins to receive specialized care in the first few months of life. When the family is prepared and has a treatment plan already in place before birth, this helps them ensure the best outcome for their child.
Almost all children with a cleft lip or palate will require surgery in order to correct the anomaly. Surgery is helpful for improving physical appearance, and it can also help improve secondary impacts of the conditions, such as hearing and speech and language development.
Prior to surgery for many infants with complete cleft lip , the Craniofacial Center utilizes a pre-surgical technique known as nasoalveolar molding (NAM) treatment. This is a harmless acrylic device that is typically fitted and placed in the child’s mouth and on the face shortly after birth. Approximately every two weeks, the “alveolar segments” of the device are adjusted, which helps restore the relationship between the skeleton, cartilage and soft tissue prior to surgery. A nose piece is usually added to the Nasoalveolar Molding at some point during the treatment to further support the nose and promote tissue growth. In our experience, this may reduce the number of surgeries required for your child, and also facilitates the outcome.