Cleft lip and palate is a condition that affects approximately 1 in 500 new births each year in the U.S. Among Asians, the incidence is twice as high as in Caucasians. Many do not realize that the surgical treatment for cleft patients is an integral part of a plastic surgeon’s training. Because of the specialized techniques and the advanced training required for these procedures, plastic surgeons that have chosen to care for cleft patients are often affiliated with academic medical centers across the U.S.
The etiology for clefting is unknown. Genetic studies have shown some familial associations between generations; more recent work has focused on localizing several potential genes that may be responsible for clefting. However, presently, most scientists believe that there are multiple causes contributing to the formation of congenital clefts. The prevailing theory is a failure of fusion of facial structures during gestation. Clefting (or gapping) can occur in the palate, the lip, or both; the facial and intra-oral deformities have varying severity. There can also be other developmental conditions or syndromes associated with cleft lip/palate.
What to expect
If you can imagine a son or daughter, nephew, sibling, or other family member with a cleft lip or palate, it is easy to understand that this can be an emotionally and psychologically devastating occurrence. Fortunately, with a proper team approach to medical care, these babies will usually live normal and healthy lives. The plastic surgeon is usually the team leader and determines the timing of surgeries (3 to 7 operations from birth to adulthood). General health, feeding, speech, dentition, breathing, ear infections, and psychosocial development are all important considerations. Thus, orthodontists, pediatricians, speech therapists, Ear-Nose-Throat surgeons, nurse coordinators, and psychologists, also play critical roles in the child’s development.
Dr. Ha will begin his sequence of surgeries with a cleft lip and nasal repair (Cheiloplasty) at about 3 months of age. If there is a cleft palate, the soft palate (posterior) portion will be performed at the same time. This procedure is known as an Intravelar Veloplasty. A hole will remain in the hard palate (front) until about 18 months of age, when this remaining palate will be closed during a procedure called Palatoplasty. Additional procedures to repair the gum-line (Alveolar Bone Graft) and/or to improve speech problems (Pharyngeal Flap), will be performed between ages 4 and 10. Finally, lip revision, nasal surgery, or jaw advancement, are often necessary by the time adolescence is reached. These surgeries are best performed in accredited pediatric hospitals, such as the Children’s Medical Center of Dallas, Medical City of Dallas or Medical City of Frisco. Dr. Ha is a member of the prestigious cleft and craniofacial team – Plastic and Craniofacial Surgery for Infants and Children (website: www.kidsplastsurg.com ). He performs state of the art cleft palate and cleft lip repairs and other craniofacial reconstructions.
Recovery from these surgeries is usually rapid and the function of the lip and palate (speech) become normal. Children with clefts are as well-adjusted and as intelligent as everyone else. Their cognitive and motor skills are not particularly diminished.
Cleft teams are dedicated to providing excellent care for their patients. Plastic surgeons and health care workers frequently participate in surgical missions to indigent countries across the world to provide care for often neglected children (and adults) with clefts. Here in the U.S., most cleft patients receive the highest level of care available, while abroad, these same children are shunned and mired in poverty. They are viewed as “evil” or “demonic”, and sometimes even abandoned by their parents because of the stigma associated with “abnormal” appearances.
Despite all of the media’s focus on cosmetic surgery, it is important to recognize that this is only a part of the diverse field of plastic surgery. Caring for cleft lip and palate patients truly demonstrates the heart of why plastic surgeons do what they do – a passion for making people’s lives better.