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Children's Services

Cleft Lip and Palate

Cleft Lip and Cleft Palate are fissures in the upper lip and the palate (the bony plate at the roof of the mouth). They often occur together, and are caused by incomplete closing of the two sides of the face in the developing embryo. They are one of the most common problems found in newborns; more than 5,000 babies are born with cleft lip and/or palate each year in the U.S. The malformation can only be treated with surgeries and therapy. Left untreated, children with cleft lip or palate can suffer life-long handicaps including severe facial deformities, chronic dental and hearing problems and even malnutrition.

The Cleft Palate Program at White Memorial Medical Center program provides comprehensive evaluation and treatment for children 0-21 years, as well as adults. It is the only such program in east Los Angeles County. The program provides coordinated cleft team care at a single location, working side by side with the patient’s own pediatrician or primary care physician. This program is an important service to our community, and depends on financial gifts from generous donors for continuity.

Services

  • Plastic and reconstructive surgery
  • Newborn nursery consultations
  • Genetics
  • ENT/audiology
  • Dentistry
  • Comprehensive pediatric rehabilitation services
    • Speech language therapy
    • Occupational therapy
    • Feeding therapy
    • Physical therapy
  • Nutrition consultations
  • Social services
  • Image enhancement services
  • Comprehensive surgical services

Cleft Palate Continuum of Care: Birth to 18 Years of Age

10 WEEKS

  • This is the earliest treatment can begin
  • The first treatment is outpatient surgery to close the skin and muscle of the lip

6 MONTHS

  • The child should have a hearing test by or before 6 months. In 90 percent of cleft palate children, the muscle that allows the middle ear to release pressure and drain fluid does not function.
  • In addition to frequent ear infections, there may be hearing loss, which can impede speech development.
  • The insertion of “ear tubes” that drain the middle ear

10 MONTHS

  • Surgery to close the palate (roof of the mouth). Hospital stay of 2-3 days.
  • The child must be off the bottle before the palate can be repaired. If the child is still on the bottle, the surgery will not be successful.
  • The child must also weigh at least 17 pounds; children smaller than this are at high risk for surgical complications.

3-5 YEARS

  • This is the next stage of treatment.
  • Repair of small holes in the palate. As the roof of the mouth heals from the first surgery, the muscles pull and small holes may result.
  • Second surgeries to repair the lip and nose. Scar tissue from the first surgery at 10 weeks does not grow as fast as normal tissue, pulling the skin of the lip and nose out of place again.
  • Speech therapy begins. Because the structures of the palate are malformed, the child often has trouble, often severe, articulating. For example, “p” comes out sounding like “k.”
  • Psychosocial support for the child, who often endures teasing, especially after beginning school or pre-school.

5-9 YEARS

  • Assessment every 6 months.
  • Orthodontic evaluation. Teeth can grow in in the palate, outside the palate and in other places they should not be.
  • Surgery to help with speech problems. An ear, nose & throat doctor, assisted by a speech pathologist, uses a fiber optic light and a video camera to determine anatomically why the child’s speech problems are occurring. Surgical repair can greatly enhance the child’s ability to speak clearly and be understood. Often more than one surgery is needed.

9-12 YEARS

  • The gum area at the front of the mouth was left open in earlier surgeries to allow for changes during the child’s growth. Now a bone graft is performed to close this gum area, using bone from the hip to fill in the gap between the gums. Requires just an overnight hospital stay.
  • Dental/orthodontic follow-up
  • Ongoing health assessments

18 YEARS

  • Additional nose and/or lip surgeries may be needed. Again, growth spurts may cause scar tissue growth to lag behind and pull the nose and lip out of proper alignment again.
  • Psychosocial support.
  • Genetic counseling. People with cleft lip or palate have a 2-5 percent chance of having one or more children with the condition.
  • Completion of any treatment not previously done.
  • Coverage for cleft palate care ends at age 21. After that time it is considered “cosmetic” surgery and not covered by insurance.