Cleft Lip and Palate
In 1983-1984, Dr. Fisher was chief of the Cleft Lip Clinic at the United States Navy National Medical Center. Revision of cleft lip nasal and lip deformities is one of the most rewarding of reconstructive surgeries.
In the early weeks of development, long before a child is born, the right and left sides of the lip and the roof of the mouth normally grow together. Occasionally, however, in about one of every 800 babies, those sections don’t quite meet. A child born with a separation in the upper lip is said to have a cleft lip. A similar birth defect in the roof of the mouth, or palate is called a cleft palate. Since the lip and the palate develop separately, it is possible for a child to have a cleft lip, a cleft palate or variations of both.
In cleft lip surgery, the most common problem is asymmetry, when one side of the mouth and nose does not match the other side. The goal of cleft lip surgery is to close the separation in the first operation. Occasionally, a second operation may be needed.
In cleft palate surgery, the goal is to close the opening in the roof of the mouth so the child can eat and learn to speak properly.
At your initial consultation, Dr. Fisher will discuss the details of the procedure he will use and answer any questions you may have about feeding your baby, by breast or by bottle, both before and after the surgery.
CLEFT LIP SURGERY
A cleft lip can range in severity from a slight notch in the red part of the upper lip to a complete separation of the lip extending into the nose. Clefts can occur on one or both sides of the upper lip. Surgery is generally done when the child is about 10 weeks old.
To repair a cleft lip, Dr. Fisher will make an incision on either side of the cleft from the mouth into the nostril. He will then turn the dark pink outer portion of the cleft down and pull the muscle and the skin of the lip together to close the separation. Muscle function and the normal “cupid’s bow” shape of the mouth are restored. The nostril deformity often associated with cleft lip may also be improved at the time of lip repair or in a later surgery.
RECOVERING FROM CLEFT LIP SURGERY
Your child may be restless for awhile after surgery, but Dr. Fisher will prescribe medication to relieve any discomfort. Elbow restraints may be necessary for a few weeks to prevent your baby from rubbing the stitched area.
Any dressings will be removed within a day or two and the stitches will either dissolve or be removed within five days. Dr. Fisher will advise you on how to feed your child during the first few weeks after surgery.
CLEFT PALATE SURGERY
In some children, a cleft palate may involve only a tiny portion at the back of the roof of the mouth. For others, it can mean a complete separation that extends from front to back. Just as in a cleft lip, cleft palate may appear on one or both sides of the upper mouth. However, repairing a cleft palate involves more extensive surgery and is usually done when the child is nine to 18 months old so the baby is bigger and better able to tolerate surgery.
To repair a cleft palate, Dr. Fisher will make an incision on both sides of the separation, moving tissue from each side of the cleft to the center or midline of the roof of the mouth. This rebuilds the palate, joining muscle together and providing enough length in the palate so the child can eat and learn to speak properly.
RECOVERING FROM CLEFT PALATE SURGERY
For a day or two, your child will probably feel some soreness and pain which is easily controlled by medication. During this period, your child will not eat or drink as much as usual so an intravenous line will be used to maintain fluid levels. Elbow restraints may be used to prevent your baby from rubbing the repaired area. Dr. Fisher will advise you on how to feed your child during the first few weeks after surgery.