Pediatric Otolaryngology

Cleft and Craniofacial Program

Cleft lip and cleft palate are among the most common birth anomalies seen in infants. Orofacial clefts affect the ability of infants to feed and speak properly and the deformity affects future dental development and breathing through the nose. Consequently, the rehabilitation of patients with cleft lip and palate requires the services of multiple clinical specialists, staged surgical procedures and long-term follow up. For some patients, the cleft is part of a syndrome or the patient may have associated malformations that also require attention.

Ultrasound imaging in the second trimester of pregnancy can depict many details of the child's face. If he or she has a cleft lip, it may be detected during pre-natal ultrasound evaluation. The obstetrician can refer the family to the cleft team prior to delivery so they can meet the surgical team and begin to prepare for treatment.

The Cleft and Craniofacial Program provides services to affected patients and their families and includes a core team of specialists. The Cleft Team members are drawn from the areas of pediatric otolaryngology, plastic surgery, speech and language pathology, dental medicine, genetics, audiology, pediatrics and neonatology.

Care is coordinated among all clinical team members with close communication with parents and primary care providers. The infant will be evaluated in the neonatal intensive care unit once a referral is made to the cleft team and follow-up shortly after discharge will be arranged with the surgeon who will repair the child's cleft. Additional follow-up appointments will also include the child's pediatrician, a feeding specialist, a genetics specialist, and possibly other pediatric specialists, depending on any other medical issues discovered during the child's initial evaluation in the Hospital.

Repair of the cleft lip is performed when the child is between six and 12 weeks of age and may be performed in one or two stages. Typically, the repair is completed by the time the child is six months old.

Cleft palate surgery is performed when the child is older, between nine and 15 months of age. Older children may have types of clefts that do not become apparent until school age and these patients will be evaluated by the team. Additionally, many adult patients who had surgery for a cleft lip or palate may have continued functional problems and may also seek evaluation and care with clinicians in the cleft program.

The Cleft Program also accepts referrals for microtia (small, underdeveloped ears), velopharyngeal insufficiency, micrognathia (small jaw)/Pierre Robin sequence, Treacher Collins syndrome and other craniofacial syndromes.