Infancy to Adulthood
Infancy
Before initially closing the infant's lip, the use of a presurgical prosthesis called a palatal appliance is helpful in positioning the maxillary segments and narrowing the gap between them. This also helps to establish a normal alveolar arch which is essential for future dental occlusion.
Ages Birth to Five Years
During the first two years of life, the cleft lip and/or palate are surgically repaired. Timing of these events is detailed in previous sections.
The first five years is a time when ear problems may be present, especially in children with cleft palate. Regular assessments by the otolaryngologist are necessary to check the grommet tubes, to maintain a healthy middle ear and to prevent hearing loss.
Regular six-month checkups are performed by the plastic surgeon to assess the effects of cleft lip, cleft palate and nose surgery. If no complications arise and aesthetic and functional results are satisfactory to the parents, additional surgery will not be performed. At a later age, some changes in appearance or function may require surgical correction.
In children who have more marked deformities, secondary lip or nasal surgery may be recommended. In addition, surgery may be necessary to correct any residual deformity, excessive scarring or other problems. Six month checkups will also be performed by the speech pathologist to monitor the functioning of the speech mechanism and speech development. If speech problems arise at four to five years of age, another surgery to correct speech production may be necessary.
The pedodontist will also see the child regularly to assure good oral hygiene and to correct any problems involving the primary (baby) teeth. Maintaining healthy primary teeth is important to good development of the secondary or permanent teeth. Regular six-month checkups are recommended.
The early years lay the foundation of the child's healthy social and psychological development. A psychosocial evaluation is available through a physician's referral if problems in this area arise.
Ages Five to Ten Years
During the ages of five to ten years, the child is placed in active orthodontic treatment. If bone grafting is required to correct the alveolar ridge, it is usually done during this time. Final speech assessment is also completed.
If speech problems are diagnosed, speech therapy begins. Speech problems that are caused by a shortening of the soft palate or velopharynx are called velopharyngeal insufficiency and may require additional surgery. One of the procedures used to surgically correct velopharyngeal insufficiency is a pharyngeal flap. Another procedure is a pharyngoplasty.
Periodic assessments by all members of the cleft palate team allow for the timely discovery of problems that require additional intervention. The problems may require surgical treatment by a plastic surgeon, the continuation of treatment by ear specialists, additional speech evaluation or several consultations with psychologists and social workers.
Ages Ten Years to Adult
During adolescence, orthodontic treatment is completed and residual speech problems are corrected. Surgery is aimed at balancing and refining facial appearance, as well as at achieving normal function. Secondary nasal surgery is aimed at improving the shape of the nose and relieving any obstruction to facilitate the easy flow of air through the nostrils. Surgery may be required to correct any deformity or crookedness of the nasal septum. External reconstruction of the nose may involve cartilage grafts taken from the nasal septum or the ear. These grafts help to repair contour deficiencies or irregularities of the nasal shape. To improve breathing, the surgeon may need to straighten the septum.