Fletcher Allen, a Vermont university hospital and medical center, serves all of
Vermont and the northern New York region. Located in Burlington, Fletcher Allen is a regional, academic healthcare center and teaching hospital in alliance with the University of Vermont.
Cleft Lip and Palate
Cleft lip and palate are common birth defects in the United States, affecting about one in 700 infants every year. A cleft refers to an opening or split in the upper lip or the roof of the mouth – or both.
The condition can affect one or both sides of the upper lip. Cleft lip and palate are often isolated birth defects, but they can also be associated with other genetic conditions. They may be related to other medical issues such as impaired feeding, speech, dental development and hearing. Most cases of cleft lip and palate are believed to be caused by genetic or environmental factors.
Team Approach
Since cleft lip and palate may present other medical challenges for your child, we provide a team approach to care that addresses the full range of issues related to the condition. Our plastic surgeons work closely with other specialists who assess your child’s ability to speak, eat and hear, as well as restore a more normal appearance.
Diagnosis of Cleft Lip & Palate
Most cleft lip and palate conditions are discovered at birth. Increasingly, cleft lip and palate are diagnosed by ultrasound during pregnancy. We are happy to schedule a consultation to discuss a prenatal diagnosis. If your child’s condition is related to a genetic condition, genetic testing may be recommended to help determine the best treatment. You may wish to contact the Fletcher Allen Genetics Center at the Vermont Children's Hospital.
Cleft Lip & Palate Treatment
Treatment for cleft lip and palate involves surgery to correct the defect. It also involves additional therapies that may be needed to treat speech, developmental or cognitive issues. Fletcher Allen plastic surgeons are members of the Vermont State Children with Special Health Needs craniofacial and cleft palate clinic, a specialized team of health care professionals, including practitioners from other disciplines, who work closely with you and your family to develop a treatment plan for your child. The Vermont State Children with Special Health Needs Cleft Palate Clinic is a team affiliated with the American Cleft Palate-Craniofacial Association.
Cleft lip and palate treatment are performed at different times in your child’s development:
- Infants whose upper jaw shape is out of alignment, from a cleft, may benefit from preoperative molding prior to cleft lip surgery -- either with an orthodontic appliance or external force from adhesive tape. This treatment is most successful if begun soon after birth.
- Cleft lip surgeries are usually performed on children at least 10 weeks old, weighing at least 10 pounds.
- Cleft palate repairs take place when a child is a little older, usually between 9 and 18 months.
- After cleft palate surgery, some children may still experience hypernasal speech (when too much air comes out of the nose). In those cases, additional evaluation is needed as their speech develops, to determine if further surgery is may be required to improve speech.
- In cases where the cleft involves the alveolus (the bone that supports the teeth), bone grafting surgery may be needed to prevent loss of the child’s permanent teeth when they come in.
- After adolescence, further surgery may be recommended to improve the jaw’s position (for an under-bite, for example), or to improve the child’s appearance.
Periodic evaluation by a multidisciplinary treatment team is recommended to develop the proper treatment plan for him or her.
For more information on cleft lip/palate, visit the Cleft Palate Foundation. You can also read a blog post on cleft lips and palates by Don Laub, MD, plastic surgeon at Fletcher Allen and interim division chief of Plastic Surgery and a professor at the University of Vermont College of Medicine.
Velocardiofacial Syndrome
The majority of patients with cleft palate have no genetic component or associated syndromes, however a significant number of people do. One of the more common syndrome associated with cleft palate is velocardiofacial syndrome (also known as Di George syndrome, Schpritzen syndrome, or 22q deletion syndrome). Children with this syndrome may have heart problems, immune system problems, or problems with calcium metabolism in addition to cleft palate. Usually, there is a missing piece of one chromosome (22q deletion), and this can be detected with special blood testing. You may wish to contact the Fletcher Allen Genetics Center at the Vermont Children's Hospital.
For more information on Velocardiofacial syndrome see the Velocardiofacial Syndrome Education Foundation.
