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Cleft Lip and Palate in Children

Cleft Lip and Palate in Children - How to prevent?

Cleft Lip and Palate in Children - Preparing for surgery

Cleft Surgery

Surgical intervention aims to:

  1. Repair affected structures and restore facial aesthetics
  2. Establish adequate function of the lip and palate
  3. Identification and treatment of other abnormalities

The treatment required for a child with a CLP depends on the severity of his /her condition. He /she may need several surgeries. Your child's Plastic Surgeon will explain your child's surgical plan to you.

Your child will be followed up with by a multidisciplinary cleft team from birth to adolescence, which usually comprises the following professionals:

  • Plastic Surgeon (Primary physician overseeing management of your baby’s care)
  • Clinical Coordinator
  • Plastic Specialty Nurse
  • Ear, Nose and Throat (ENT) Surgeon
  • Speech and Language Therapist
  • Orthodontist
  • Geneticist
  • Psychologist

Clinical Coordinator

The Clinical Coordinator helps to coordinate interdisciplinary care for your child. He/she conducts antenatal counselling and provides support to families expecting a child with a cleft.

Plastic Specialty Nurse

The Plastic Specialty Nurse is a Registered Nurse who specialises in the care of children with cleft and/or craniofacial anomalies. The nurse will work closely with you and your child by sharing information and assisting you with feeding techniques, and pre and post-surgery wound care management.

Ear, Nose and Throat (ENT) surgeon

Babies born with a cleft palate are more prone to have fluid build-up in the middle ear that may lead to ear infections, or some degree of conductive hearing loss. The ENT Surgeon assists with management of your child’s hearing, and may recommend draining the middle ear fluid by inserting ventilation tubes (grommets).

Speech and Language Therapist

The Speech Language Therapist (SLT) is responsible for the assessment, identification and management of communication disorders in individuals with cleft and/or craniofacial anomalies. The SLT will also provide advice as to the need for and timing of therapy, or surgical repair of the palate to facilitate speech if required.

Orthodontist

For newborn infants right after birth, the Orthodontist performs nasoalveolar molding (NAM) using a non-surgical device that helps to shape the gums, lip and nose. This prepare the babies for lip repair surgery by the Plastic Surgeon.

When your child is older (7-13 years old), orthodontists provide early orthodontic treatment to prepare your child for bone grafting at the nose and upper jaw areas.

For patients requiring jaw surgery, the orthodontist monitors them until they are skeletally mature (usually late teens and early adulthood), whereby they then commence orthodontic treatment in conjunction with jaw surgery.

Geneticist

A referral to a Geneticist for further genetic testing may be required to identify any underlying cause of the cleft. The Geneticist will then be able to counsel parents regarding the risk of clefting in subsequent children.

Psychologist

Your child may be referred to a Psychologist to support him/her and your family through any psychological and/or emotional stressors.

Recommended schedule for surgery

  • Cleft lip repair at 3 – 6 months
  • Palate repair at 6 –12 months
  • Speech surgery at 5 – 6 years
  • Alveolar bone grafting at 7 –13 years
  • Maxillary advancement (i.e., jaw surgery) at 17 year old and above
  • Secondary soft tissue surgery and/or rhinoplasty at 17 – 18 years

Preparation for operation

Your child will likely be hospitalised for three to five days. You may stay with your child throughout their hospitalisation.

We advise that you keep your child away from individuals who have cough, flu or other infections in the weeks leading to the operation. This reduces the chance that the surgery may have to be postponed in the event that your child is unwell. Your child will be admitted the day before the surgery at the Admission Office between 12pm to 2pm. You are required to bring along the KKH Admission Authorisation Form and your child’s Birth Certificate.

Your child’s Plastic Surgery Team will meet you in the ward to explain the surgical procedure in detail, discuss any worries you may have, and obtain your consent for surgery. If your child is planned to undergo multiple procedures within the same surgery (e.g., grommet insertion or dental extractions), the respective medical professionals will meet you as well.

An anaesthetist will visit you the day before the surgery to explain the procedure for undergoing general anaesthesia and instructions for fasting.

For general information about preparing your child for surgery, you may log on to: http://www.kkh.com.sg/patient-care/conditions-treatments/preparing-for-operation

The information provided is not intended as medical advice. Terms of use. Information provided by SingHealth

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