Cleft Lip & Palate

Discover how cleft lip and palate surgery can transform your child's life, offering a path to improved appearance, speech, and overall well-being.

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Improve Your Child’s Quality of Life with Dr. Panossian in Pasadena

If your child is living with a cleft lip and palate, it's natural to have concerns about their appearance, speech development, and long-term quality of life. Dr. Panossian understands these emotional challenges and offers specialized expertise in cleft lip and palate surgery, backed by extensive training in reconstructive and cosmetic surgery and craniofacial surgery at the prestigious Hospital for Sick Children in Toronto and Harvard Medical School. With Dr. Panossian's skill and compassion, you can find relief for your insecurities and fears, knowing your child's condition is in expert hands.

Reconstructive Surgery Overview

Welcome to Our Practice

Understanding Cleft Lip & Palate

Cleft lip and cleft palate deformities manifest at birth and stem from anomalies occurring during the 4th through 7th weeks of human embryonic development. These crucial weeks witness the fusion of various facial structures, aiming to unite the face's two halves with a central prominence. When this fusion fails to occur, it results in a cleft lip and/or palate, with presentations and severities varying depending on the degree of fusion.

Causes and Types

A unilateral cleft lip denotes a failure of fusion on one side of the upper lip, aligning with the native philtral column of Cupid's bow. Conversely, a bilateral cleft lip occurs when the outer face fails to fuse with the central nasal prominence, leading to two separate gaps in the upper lip with a central loose segment. Frequently associated with a cleft lip, a cleft palate can also manifest as an isolated deformity. The process of palate formation, from the primary palate to the soft palate, is continuous, and any failure of fusion during this process can result in a speech disturbance. The cleft lip and palate spectrum includes various configurations and severities, categorized as partial (incomplete) or complete (total failure of fusion).

Cleft lip and palate are among the most common birth deformities in the United States, with an estimated occurrence rate of 1 out of 700 live births. While the exact cause of over 60 percent of these deformities remains unknown, their incidence is multifactorial. Environmental factors such as maternal smoking, alcohol consumption, certain medications, recreational drugs, steroids, and folate deficiency are potential contributors. Racial prevalence also plays a role, with Asian populations exhibiting the highest prevalence, followed by Caucasians and individuals of African ancestry. Additionally, boys have a higher prevalence than girls. Certain genetic associations are linked to higher cleft lip and palate rates, including trisomy 21, 18, 13, and craniofacial syndromes. Developmental delay may also be associated with genetic disorders.

Associated Issues and Hereditary Factors

Cleft lip and palate can lead to various challenges beyond cosmetic concerns. In addition to the visible deformity of the lip, issues such as ineffective breastfeeding, speech difficulties, dental anomalies, and nasal deformities may arise. Depending on the underlying cause, additional complications such as cardiac abnormalities, learning difficulties, and syndromic deformities may also be present. Specialized nipples, such as those from Haberman or Pigeon, may be utilized to aid in feeding when a proper suck is lacking.

Furthermore, the likelihood of passing on cleft lip and palate to future generations varies depending on several factors. In cases with no known genetic condition, a parent with a cleft has approximately a 4 to 6 percent chance of transmitting the condition to their child. If a child is born with a cleft to non-affected parents, the likelihood of having another child with a cleft ranges from 2 to 8 percent. When both parent and child have a cleft, the risk increases further. Generally, the more affected family members there are, especially in cases of bilateral cleft variants, the higher the probability of passing on the deformity. Consulting with a genetics counselor is essential for understanding the various factors contributing to cleft lip and palate deformities and making informed family planning decisions.

Cleft Lip & Palate Diagnosis & Treatment

While cleft lip and palate are typically apparent at birth, formal diagnosis may still be conducted to confirm the condition's extent and assess any associated health concerns. Diagnosis usually involves a physical examination of the affected area, possibly supplemented by imaging tests such as ultrasound or magnetic resonance imaging (MRI). Additionally, genetic counseling may be recommended to evaluate any potential familial or hereditary factors contributing to the condition. Surgery is currently the primary treatment for correcting cleft lip and palate deformities. Lip repair is typically performed around three months, whereas palate repair (palatoplasty) is usually done around ten months. Lip repair involves repositioning adjacent segments of the upper lip to restore continuity and function, focusing on repairing the mucous lining, muscle, and skin layers.

Considerations for surgical repair differ for unilateral versus bilateral cleft lips, with the concepts and goals of repairing the three layers of the upper lip remaining consistent. Palatoplasty entails closing the oral and nasal mucous linings and intervening muscle layers to facilitate proper speech development and function. Surgery may also be combined with other procedures, such as ear examinations or bone grafting for gum line clefts, to address associated concerns comprehensively. Revision surgery or secondary procedures may be required in some cases to refine cosmetic or functional outcomes, and these interventions are tailored to the individual's specific needs and circumstances. Multidisciplinary collaboration between plastic surgeons, oral and maxillofacial surgeons, orthodontists, speech therapists, and other specialists is often essential to optimize treatment outcomes and long-term quality of life.

The Benefits of Cleft Lip & Palate Surgery

While living with a cleft lip and palate is manageable, it can present emotional challenges for patients. All any parent wants is to see their child happy, healthy, and confident. Dr. Panossian, in Pasadena, CA, recognizes the weight of this journey, offering compassionate care and expertise to provide relief. The benefits of cleft lip and palate surgery extend beyond physical transformation, offering a brighter future for your child. Discover the transformative benefits of surgery below:

Improved Facial Appearance

Surgery can help correct the visible deformities associated with cleft lip and palate, restoring symmetry and enhancing facial aesthetics. This improvement can boost your child's self-esteem and confidence as they navigate social interactions and develop relationships.

Enhanced Speech Development

Cleft lip and palate surgery can address structural abnormalities affecting speech production. By improving the function of the palate and oral muscles, surgery can facilitate clearer speech and better communication skills, allowing your child to express themselves more effectively.

Optimized Feeding Ability

Surgery can improve your child's ability to feed effectively, addressing breastfeeding or bottle feeding challenges. By repairing the cleft lip and palate, surgery creates a more functional oral cavity, making feeding a more comfortable and successful experience for your child.

Reduced Risk of Dental Issues

Untreated cleft lip and palate can lead to dental problems such as misalignment, overcrowding, and malocclusion. By addressing the underlying structural issues through surgery, your child can enjoy better dental health and a reduced risk of complications later in life.

Improved Quality of Life

Ultimately, cleft lip and palate surgery can significantly improve your child's quality of life by addressing physical, functional, and emotional challenges associated with the condition. With Dr. Panossian and his team's support, your child can thrive and embrace a brighter, more confident future.

What to Expect The Cleft Lip & Palate Surgery

Cleft lip and palate repair surgeries are typically performed under general anesthesia and may require an overnight hospital stay for observation, particularly in the case of palate repair. Lip repair involves moving adjacent segments of the upper lip together to re-establish continuity and function. Repairing the underlying muscle sphincter (orbicularis oris) is vital to restoring proper upper lip function. Palate repair involves repairing the hard and soft palate layers separately, ensuring proper soft palate repair, which is critical for speech development. Additional procedures may be performed as needed, such as bone grafting for gum line clefts or secondary speech-improvement surgeries. Surgical times vary depending on the complexity and extent of the procedure but generally range from 2 to 3 hours. Some surgeries may involve combination procedures, such as ear examinations under anesthesia or bone grafting. Recovery from surgery involves close monitoring for bleeding or respiratory difficulties, along with a soft diet and restrictions on physical activity as appropriate. Postoperative follow-up visits are typically scheduled to assess healing progress and address concerns. Surgical or secondary procedures may be considered based on individual needs and outcomes.

Cleft Lip & Palate Surgery Recovery

Following cleft lip repair, many centers now practice outpatient procedures. The incision is typically sealed with skin glue or small sutures, which may require removal after one week. Children can resume feeding immediately after surgery and return to their usual level of physical activity, supervised but without restraints, as infants typically do not feel the urge to manipulate the surgical site. Parental involvement is crucial, and a "less-is-more" approach is often favored. Follow-up appointments are scheduled at 1 and 4 weeks postoperatively, during which scar management techniques such as massage, taping, sunblock application, and moisturizing cream usage may be introduced.

In contrast, cleft palate repair usually necessitates overnight hospitalization to monitor potential bleeding or respiratory complications. The child's ability to maintain oral hydration and feeding is closely observed, with some expected oral and nasal bleeding for up to one week postoperatively. Follow-up appointments occur at 1 and 6 weeks postoperatively, during which a soft diet is mandated while the child is allowed to resume regular physical activity immediately after surgery.

Speech therapy is integral to cleft palate management, as approximately two-thirds of patients may experience speech disturbances, often characterized by excessive nasal air escape or hypernasality. Early intervention is key to preventing the formation of improper speech habits that can exacerbate long-term speech difficulties. While about one-third of patients may achieve improvement with long-term speech therapy alone, another third may require surgical intervention to enhance palatal movement efficiency and reduce hypernasality. This surgical intervention, performed by Dr. Panossian, aims to make speech more intelligible and can significantly improve long-term outcomes for patients with cleft lip and palate.

Risks and Potential Complications of Cleft Lip & Palate Surgery

While cleft lip and palate surgeries have undergone extensive refinement over decades, like any surgical procedure, they carry inherent risks and potential complications. These include the possibility of bleeding, infection, or anesthesia-related issues, albeit rare. For cleft lip repair, there's a slight risk of undesirable scarring, such as hypertrophic scarring or keloids, along with the potential for residual deformities like excessive upper lip bulk or asymmetry. In rare cases, wound dehiscence, or separation, may occur post-surgery, necessitating possible revision surgery for correction.

In cleft palate repair, there's a risk of incision line breakdown, with potential communication between the oral and nasal cavities, known as oronasal fistula, which may require repair if significant or affecting speech. Soft palate repair dehiscence could impair palatal muscle function, necessitating corrective measures. While extremely rare, postoperative airway swelling leading to respiratory difficulties may occur. Additionally, persistent speech issues are common, underscoring the importance of early intervention with a speech therapist.

Secondary procedures for speech correction, such as velopharyngeal insufficiency (VPI) treatment, carry additional risks, including respiratory compromise, albeit rare. There's also a possibility of exacerbating sleeping difficulties like obstructive apnea or snoring in some cases. Despite efforts to improve speech, procedures may not always fully address speech concerns, leading to ongoing reliance on speech therapy for long-term management.

Why Choose Dr. Panossian?

As you navigate the decision-making process for your child's cleft lip and palate surgery, it's essential to choose a surgeon with the expertise and compassion to provide the best possible care. Serving patients in Glendale, Pasadena, and the greater Los Angeles area, Dr. Panossian stands out as a true expert in the field. Combining mastery in reconstructive and cosmetic surgery with specialized training in craniofacial surgery from renowned institutions like the Hospital for Sick Children in Toronto and Harvard Medical School, choosing Dr. Panossian means you can trust that your child will receive the highest quality of care tailored to their unique needs and designed to enhance their appearance, speech, and overall quality of life. Take the first step toward a brighter future for your child and schedule a consultation with Dr. Panossian today.