Cleft lip and palate is the most common congenital abnormality worldwide, affecting 1.7 in every 1000 babies born. A child may have a cleft (a deep split) in their upper lip, in the roof of their mouth, or both. Cases of cleft lip and palate can vary widely: minor cases may be nothing more than a small notch on the top lip, while severe cases can leave the child with a deep groove from the lip extending the full length of the mouth to the nose, making breathing and eating difficult. Children with cleft lip and palate may also experience loss of hearing and are more prone to ear infections.
What causes cleft lip and palate?
There are several possible causes of cleft lip and palate, including a genetic mutation or exposure to some drugs during pregnancy. Those that carry a high risk include epilepsy drugs (phenytoin and sodium valproate), benzodiazepines and steroids. Being exposed to a virus, drinking alcohol, or smoking when pregnant are also thought to be possible causes of cleft lip and palate. There is also some evidence to suggest that not getting enough folic acid can be a factor. In some cases, cleft lip and palate can occur alongside other birth defects, such as heart defects, growth disorders, or learning difficulties.
How is cleft lip and palate detected and treated?
Cleft lip and palate can sometimes be detected during pregnancy using a high resolution ultrasound scan at around 20 weeks. If not, it is detected at birth, which may be more of a shock to parents. Early detection and treatment are crucial since cleft lip and palate can affect not only your child’s appearance, but also their ability to eat and speak.
Ideally, cleft lip and palate surgery is performed on the lip before your child is three months old, and on the palate in a second operation before they are a year old. As your child grows, they may need a bone graft to close the gap in their gum at around the age of 9, or orthodontic surgery to correct the alignment of secondary teeth. Over time, your child may benefit from plastic surgery to improve appearance of the lip and nose and revise scarring following previous cleft lip and palate surgeries. Plastic surgery to the palate after the cleft has been closed can also help to improve speech.
It is important for your child to be monitored from birth until they stop growing at around 18 years, as you may find that more plastic surgery may be beneficial as their facial features grow and develop.
What other types of plastic surgery are available for children?
Plastic surgery is also used to correct protruding ears, which are often called bat ears. A procedure known as otoplasty or pinnaplasty to pin back the ears is possible from around the age of 5. Plastic surgery can also be used to remove birthmarks; this requires a very good surgeon as the scarring left behind by plastic surgery may be more unsightly than the birthmark itself.