BILATERAL CLEFT LIP

Description of Bilateral Cleft Lip

Bilateral cleft lip are a more severe form of clefting than unilateral cleft lip because the lip is divided into three segments: the clefts occur along both philtral columns, creating two lateral segments and a middle segment which has neither muscles nor vermilion. Bilateral cleft lip may be either symmetrical or asymmetrical, in which case the cleft lip is split more on one side than on the other. Patients with Bilateral cleft lip; the nasal deformity is associated with severe clefting of the lip. When the cleft extends only into the lower portion of the lip and is symmetrical, the nose may not be affected. It is important in this cleft form that the alveolus, teeth and palate remain intact. 

Expectations and Treatment of Bilateral Cleft Lip

Surgery is the only treatment necessary for patients with Bilateral cleft lip. Depending on the severity of the cleft lip, it may be performed in one or two stages. If surgery is performed in one stage, both sides are operated on, and the cleft lip is totally reconstructed. When the procedure is performed in two stages, each side is closed in a separate operation. The decision depends on the severity of the cleft lip.

Every patient's case is unique. Please contact us for a consultation.

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BILATERAL CLEFT LIP AND ALVEOLUS

Description of Bilateral Cleft Lip and Alveolus

Bilateral cleft lip and alveolus is rare. It is when the lip, as well as the alveolar bone, is split into three segments. In the majority of patients with this cleft, the lip is split completely on both sides; however, the alveolar bone is not always completely divided. It may be split on one side and have only a groove or indentation on the other side. On very rare occasions, when the bone is separated completely on both sides, the middle bony segment may grow beyond the limits of the alveolar arch and protrude forward and even downward. This middle segment of the alveolar bone is called the premaxilla. 

Expectations and Treatment of Bilateral Cleft Lip and Alveolus

When this occurs, the treatment requires high expertise from the orthodontist and surgeon who place the premaxilla within the alveolar arch to assure normal dental occlusion. Orthodontic treatment starts as early as possible. Cleft lip repair is performed at approximately three months of age. Depending on the position of the premaxilla, it may require surgical-orthodontic treatment and bilateral bone grafting at a later age.

Every patient's case is unique. Please contact us for a consultation.

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BILATERAL COMPLETE CLEFT OF THE LIP, ALVEOLUS AND PALATE

Description of Bilateral Cleft of the Lip, Alveolus and Palate

This is the most severe form of cleft lip. It involves the lip, nose, upper jaw, teeth and palate. Clinically, bilateral cleft of the lip, alveolus and palate is similar to bilateral cleft lip and alveolus with the additional palatal defect. The palatal defect creates an open communication between oral and nasal cavities so that food and fluids from the mouth can pass easily into the nose. This requires special feeding precautions which are discussed later. The presence of a palatal cleft lip interferes with normal speech production. Thus, even after the palatal cleft lip is closed, speech may still be affected, requiring further treatment by speech pathologists and surgeons. These patients with this type of cleft lip may need long-term speech therapy. Approximately twenty percent of these patients may require a pharyngeal flap. 

Expectations and Treatment of Bilateral Cleft of the Lip, Alveolus and Palate

The treatment of bilateral cleft lips requires close cooperation among the plastic surgeon, orthodontist and speech pathologist. Pre-surgical orthodontic treatment is necessary when the premaxilla is moved forward 

Surgical treatment starts at approximately three months of age with one- or two-stage lip/nose repair. In the first operation, both sides of the cleft lip are closed, and the nasal deformity is corrected. When a second surgery is necessary-as in nearly all cases of bilateral cleft lip-the secondary lip and nose operations are performed at a later age at the discretion of the surgeon and parents.Cleft lip palate repair is usually performed at six to eighteen months of age, but, in some cases, it may be postponed until two to three years of age for children with this kind of cleft lip. 

Orthodontic treatment may extend into adolescence. Speech therapy, if necessary, begins at the preschool age for children with this kind of cleft lip. Occasionally, surgical repositioning of the premaxilla may be needed together with bilateral bone grafting. This operation is usually performed at seven to nine years of age.

Every patient's case is unique. Please contact us for a consultation.

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CLEFT LIP PALATE

Description of Cleft Lip Palate

Cleft lip palate may be present without clefting of the lip and alveolus. Cleft lip palate may involve only the soft palate, the soft and part of the hard palate, or the entire palate, soft and hard. The cleft lips, especially complete cleft lips of the palate, may vary in width. The wider the cleft lips, the more difficult surgical closure becomes. Each palatal cleft lip affects speech, and, for this reason, in the treatment of cleft lip palate only, close cooperation between the surgeon and speech pathologist is necessary.

Expectations and Treatment of Cleft Lip Palate

Surgical treatment of cleft lip palate is performed at six to eighteen months of age. In eighty percent of all cases of cleft lip palate, the operation is successful in not only closing the palatal cleft lip, but also in creating normal speech. However, in approximately twenty percent of children with cleft lip palate, another surgical procedure may be necessary if the speech remains affected and has a nasal quality.
The surgery to correct speech is performed no earlier than three to four years of age on children with cleft lip palate. This operation is called pharyngoplasty or pharyngeal flap. 

Every patient's case is unique. Please contact us for a consultation.

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UNILATERAL CLEFT LIP

Description of Unilateral Cleft Lip

Unilateral cleft lip may involve part of the lip or the entire height of the lip. The degree of clefting in partial cleft lip may range from vermilion only to two-thirds of lip height. The orbicularis oris muscle may be divided only at the lower portion of the cleft lip while the rest of the muscle and skin remain intact. In many cases of partial unilateral cleft lip, the orbicularis oris muscle may be divided completely, creating a groove of the skin. Separation of the muscle may cause it to bulge on both sides of the cleft lip. 

In the great majority of cases, unilateral cleft lip is associated with a very typical nasal deformity. The nostril on the cleft side is larger than on the normal side, and it is more horizontal than oblique. The tip of the nose is lower on the cleft lip side, and the columella is shorter. 

Expectations and Treatment of Unilateral Cleft Lip

Unilateral cleft lip is the mildest cleft lip form, affecting only the lip and not affecting speech nor dentition (the development and erupting of teeth). Surgery is the only treatment required and is usually performed at approximately three months of age when the child weighs at least ten pounds. Secondary corrections, when necessary, may be performed between the ages of one and five years. 

The treatment usually starts with pre-surgical orthodontic treatment, which approximates the bony segments into a better position to facilitate lip and nose repair. This operation is performed at approximately three months of age. It is followed by cleft lip palate repair which is performed between nine to eighteen months of age. Most patients with unilateral cleft lip require further lip and nose corrections, which are performed at a later age at the discretion of the surgeon and parents

Every patient's case is unique. Please contact us for a consultation.

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