Understanding Stages of Reconstructive Surgery Helps Parents Partner with Treatment Team
Surgical treatment starting as early as two or three months of age provides the best chance of a successful outcome for babies born with cleft lip and palate, a birth defect that affects speech, hearing and swallowing as well as appearance, according to Tae Ho Kim, M.D., assistant professor at New York Medical College and Chief of Pediatric Plastic and Craniofacial Surgery at the Maria Fareri Children’s Hospital at Westchester Medical Center, and a plastic and reconstructive surgeon with the New York Group for Plastic Surgery
“Cleft lip and palate is much more than a cosmetic issue for the baby, as well as for the parents,” said Dr. Kim. “The goal of surgery to repair a cleft is to provide a balanced, symmetrical appearance and correct functional problems that seriously affect the child’s ability to eat, speak and hear.”
A cleft lip and palate are apparent at birth as a split, or gap. There are various types of facial clefts, but the most common involves the upper lip and palate. This cleft causes distortion of the lip, nose, palate and gum line. A pediatric craniofacial surgeon — an expert in defects of children’s head and facial areas — treats clefts as part of a larger medical team.
The incidence of cleft lip and palate is 1 in 600 for Asians and Latinos, 1 in 1,000 for Caucasians, and 1 in 2,000 for African-Americans. Genetics can play a part, but most often the reason a baby is born with a cleft is simply unknown. It is not the parents’ fault, and the most important thing is to seek the best treatment for the child as soon as possible.
A cleft affects a child’s appearance but can also interfere with important bodily functions such as:
— Nutrition, because the baby cannot create proper suction.
— Speech, as air can leak through the nose and result in mispronunciation
of certain important sounds.
— Hearing, since the Eustachian tubes cannot drain fluid from the middle
ears, which can result in frequent ear infections and hearing loss.
Surgical Stages Timed to Child’s Development
Proper treatment to address the many physical and emotional challenges of a cleft requires a full craniofacial team that typically includes the pediatric craniofacial surgeon, otolaryngologist (ear, nose and throat doctor), orthodontist, dentist, oral surgeon, speech pathologist, nutritionist, nurse and social worker. The baby’s parents are critical members of the team throughout the repair and recovery process.
Timing and technique are extremely important with cleft surgeries. Surgical correction for cleft lip and palate is performed in stages over the child’s growth years, often proceeding like this:
— Age 2–4 months: Initial surgical repair of the cleft lip and nose,
sometimes with orthodontic molding to reshape the gums, lip and nostrils
prior to surgery.
— Age 10–12 months: Surgical repair of the cleft palate, timed to
coincide with normal speech development. The otolaryngologist determines
the need for ear ventilation tubes.
— Age 7–9 years: Some children need a small operation to transfer a small
amount of bone from the hip to the gums to build structural support for
incoming permanent teeth.
— Age 15–19 years: The final phase of treatment happens once the child
stops growing. The craniofacial surgeon performs additional work on the
nose for breathing and appearance, or the upper jaw for bite and
appearance. The orthodontist and oral surgeon complete the final teeth
alignment, or positioning.
It is very important to find an experienced pediatric craniofacial specialist to consult with regarding treatment for a child with cleft lip and palate, as there is a risk of scarring or asymmetry that can result from surgery. Parents are advised to talk to other medical professionals and established support groups for referrals, and do research online, to find the best surgical specialist for their child.
About the New York Group for Plastic Surgery
The New York Group for Plastic Surgery is comprised of highly trained reconstructive and plastic surgeons certified by the American Board of Plastic Surgery (ABPS) and recognized for their specialized medical and cosmetic surgical skills and personalized patient care. The New York Group for Plastic Surgery serves patients from communities in the entire Hudson River Valley, New York City, Northern New Jersey, Eastern Pennsylvania and Western Connecticut, as well as patients who travel from across the United States and internationally for their expertise. http://www.nygplasticsurgery.com.
SOURCE New York Group for Plastic Surgery