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Cleft Lip and Palate Repair

Cleft lip and cleft palate are congenital birth defects. In other words, these problems occur during the developmental process in the mother’s womb. Normally, the mouth and nose of a baby develop between week 6 and week 12 of gestation (first trimester). This process involves downward growth of the nasal structures and medial (toward the middle) growth of the tissues that become the lips and mouth. In some babies, parts of the lips and roof of the mouth (palate) don’t grow together or fuse in the middle. Because the lips and the palate develop separately, it’s possible to have a cleft lip, or a cleft palate, or both.

In most cases, we simply don’t know why lip and palate development go wrong. There are some environmental factors (nutrition or vitamin deficiency, exposure to toxins, etc.), but most studies support a strong role for genetic factors. Race or ethnicity and gender do play a small role, as clefts are most common in Southeast Asians and the indigenous peoples of Central and South America. Clefts are less common in whites (Caucasians) and least common in blacks (people of African descent). Boys are slightly more often affected than girls.

There are multiple medical problems associated with the cleft lip or palate, including poor feeding, delayed speech development, and possibly hearing issues. Medical professionals with special experience in the problems of cleft lip and palate have formed multidisciplinary teams all over the country and around the world to help parents plan for their child’s care and development from birth, or sometimes from even before birth if a cleft is diagnosed by fetal ultrasound. Members of a child’s cleft lip and palate treatment team usually include:

  • an audiologist (who assesses hearing);
  • a surgeon (such as a plastic surgeon, an oral/maxillofacial surgeon, or a craniofacial surgeon);
  • a pediatric dentist or other dental specialist (e.g., a prosthodontist, who makes prosthetic devices for the mouth);
  • an orthodontist (who straightens the teeth and aligns the jaws);
  • a geneticist (who screens patients for craniofacial syndromes and helps parents and adult patients understand the chances of having more children with these conditions);
  • a nurse (who helps with feeding problems and provides ongoing supervision of the child’s health);
  • an otolaryngologist (an "ear nose and throat" surgeon, or "ENT");
  • a pediatrician (to monitor overall health and development);
  • a psychologist, social worker, or other mental health specialist (to support the family and assess any adjustment problems);
  • a speech-language pathologist (who assesses not only speech but also feeding and swallowing problems);

Treatment of clefts usually begins in the first few months of an infant’s life, depending on the overall health of the infant and the severity of the cleft. In cases where a cleft lip and a cleft palate are present, the cleft lip is repaired first, generally around 3 months of age. For cleft lip surgery, the surgeon will make an incision on each side of the cleft from the lip to the nostril. The intricate layers of the two sides of the lip are then sutured together, making sure that the muscle that helps the mouth move is repaired. All three layers of the delicate lip tissue are then repaired individually. Bilateral cleft lips require a different surgery which is more complex but based on the same principles.

In the medical field, general agreement exists that surgical correction of a cleft palate should be accomplished when patients are younger than one year old, before significant speech development occurs. The potential benefits of an intact palate as a child begins to speak are believed to outweigh the possible complications of early closure. Surgery for both cleft palate and a cleft lip require general anesthesia because of the patient’s age and the need to closely monitor the breathing and other vital signs.

The goal of repair in patients with cleft palate is to separate the oral (mouth) and nasal (nose) cavities; this separation involves the formation of a valve that is both watertight and airtight. The valve is necessary for normal speech. The repair also helps with preserving facial growth and the development of proper dentition (teeth). Cleft palate surgery involves drawing tissue from either side of the mouth to rebuild the palate. It typically requires two or three nights in the hospital, with the first night often being spent in the intensive care unit (ICU).

The necessity for more operations often depends on the severity of the cleft, its shape, and the thickness of available tissue that can be used to create the palate. Some children with a cleft palate require more surgeries to help improve their speech. Additional surgeries may also improve the appearance of the lip and nose, close openings between the mouth and nose, help breathing, and stabilize and realign the jaw. Subsequent surgeries are usually scheduled at least 6 months apart to allow a child time to heal and to reduce the chances of serious scarring. Lastly, many patients with a cleft lip have an asymmetric tip of the nose. This is partially corrected in the first surgery, but a rhinoplasty (nose reshaping) can be performed after the child finishes growing (typically in the teenage years).

Please note that all patients are different and individual healing times and results may vary. The statements regarding procedures and recovery made here are general rules.

5.0

Based on 19 reviews

Christina G.
I had several nasal/sinus issues including a severely deviated septum and a dorsal hump, which I wasn't crazy about. Dr Ransom did both the medical and aesthetic parts of my surgery and he did a wonderful job! While I did have some swelling, I didn't experience much bruising at all. I loved that he left the natural look of my nose just making small corrections. My breathing has GREATLY improved. His office staff was super helpful in scheduling and making sure payment and everything was very clear. I am very, very, very pleased with my results!!
Tk I.
I had a terrible surf accident in Bali and needed to get 50 stitches to repair what the reef did to my face. I had emergency cosmetic surgery in Bali the day of the accident. Immediately when i got back to the states i was introduced to Dr Ransom through some mutual friends. I was searching for the best cosmetic surgeon in San Francisco to help in my recovery. He and his team have been amazing! he helped establish a plan for my post-op wound care/treatment and administered some initial laser treatments. Dr Ransom and his team are extremely knowledgeable and very patient / helpful. I am very grateful for their help and support. I am finally looking normal again!
Joey B.
I had three issues with my nose - which inhibited my breathing: 1- broken nose, 2 - narrow nostrils that collapsed when I inhaled through my nose, 3 - deviated septum. When I was living in New York, I went to see a doctor about my breathing issues, and he said my skin was too thin and there was likely nothing he could do to rectify the problem. Dr. Ransom was recommended by an ENT I saw through One Medical. As soon as he saw him, he said he could easily fix my nose, and remove the bump that had formed from the trauma. His confidence and strong sense of self immediately put me at ease, and I had little doubt that he could accomplish exactly what he promised. He showed me a modified picture of my nose , and really liked what he proposed. The end result very closely matched what he promised. Not only can I now breath much more easily through my nose, it looks much better. He managed to make it look like an improved version of itself, however I still look like me, and unless I tell anyone I had it done, it's not overly noticeable, which I prefer. I'm pretty vain and very critical, and I can say that Dr. Ransom is great, and comes highly recommended.
Edward T.
Doctor Evan Ransom took my surgery on relatively short order and did a wonderful job. He is very talented and has a nice friendly professional support staff. I can not thank him enough, he was calm, caring, professional and interested in the follow results of his work . He seemed to bring a certain artistry to the profession.
Lisa C.
Dr. Ransom is a talented physician. He is knowledgeable, professional and goes the extra mile to make you feel comfortable during your treatments. He has been blessed with an artistic eye which brings wonderful results. I highly recommend Dr. Ransom and would refer all of my friends and family members to choose him as their physician.
Cheryl H.
Dr Ransom is very kind, honest, and conscience doctor. I was referred by my best friend, she is also Doctor Ransom patient. She has so much good things said about Doctor Ransom. So I had a face lift done by Doctor Ransom on July 2015. He did a wonderful job on my face and I have a lot of compliments on my face. So if anyone want to get their face done. I would highly recommended Doctor Ransom to you. I give Doctor Ransom a five stars.
Jill P.
I have currently been getting botox regularly with Dr. Ransom and he does a fantastic job. My previous doctor's office moved to another location where it was no longer convenient. I didn't realize what I was missing until I went to Dr. Ransom. I felt really comfortable, but most important he did a terrific job blowing my previous doctor out of the park. (Sometimes it's good switch it up a bit to make sure you are getting the best treatment.) On top of that, Dee the office manager is an incredible asset to the office. She personalizes your visit and relationship with the office to an extent I have never experienced before. I even get follow up calls to see how I am doing after a treatment. I highly recommend Dr. Ransom for his great work, and his team's impeccable customer service.
Arielle C.
Dr. Ransom and Dee are the BEST! Whether it's aesthetic or reconstructive, I'd trust him over and over again with my face.