What do they do when someone has a cleft palate or lip?

The types of management available for the cleft lip and palate are quite diverse and differ for each person depending on the involvement or severity of the clefting. For example, a cleft lip only is going to be managed quite differently than a bilateral (both sides involved) cleft lip and palate. The types of management available include: 1) prosthetic (artificial pieces made of plastic, etc.), 2) medical/surgical and 3) speech/language therapy. In the hospital setting, for example, a team of specialists work with the family to determine the best management type(s) to use for each patient. Most teams include an oro-facial surgeon/plastic surgeon, social worker (to help deal with everything from finding support groups to helping communicate with insurance companies), speech/language pathologist, dentist/orthodontist (many with clefts have missing or misaligned teeth), nursing, genetic specialist ( helps determine how/why/will it happen again) and pediatrician. Other specialists are added if needed.

Prosthetics involves any type of piece used to obtain closure that is not made of real skin tissue. Sometimes false "plates" are placed over the roof of the mouth in order to keep food and liquids from seeping into the nasal cavity while swallowing. Sometimes an artificial bulb shaped piece is placed back by the soft palate to reduce air flow through the nose while speaking. Each piece used is made for a specific task, such as eating or speaking. There are many different types for different tasks.

Clefts of the lip and palate need to be surgically fixed for multiple reasons. Not only are eating and speaking adversely affected, but socialization with others becomes greatly impaired as those with clefts become viewed as "different" or handicapped by others. Surgical procedures are the most important part of management in my opinion. A very skilled surgeon can repair lips especially well so they appear almost normal. It is amazing to see first hand some of the closures done with patients I have worked with. Unfortunately a lot of what a surgeon can accomplish depends on what the patient has to work with. Often times there is so little tissue available to use that they do the best they can and repairs do not look very good. Fortunately, skin is stretchable and tissue from other parts of the body are moveable in case more is needed during a later "cosmetic improvement" surgery if the first did not come out looking the most normal. A surgeon's first concern is getting open areas shut and cosmetic things are often left till another surgery. It is also amazing that they can now do initial surgical repair on babies only a few weeks old. Not many years ago it was often advised that closure not be done until the child was two or three years of age. Could imagine letting a child wait that long? Not me! Medical technology for cleft repair is ever evolving and getting better all the time.

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