Primary Treatments

Unilat lip figure, artist renderingCleft Lip & Palate

Cleft lip and cleft palate are birth defects that result in openings or splits in the upper lip, roof of mouth (palate) or both.  It results when facial structures developing in an unborn baby do not close completely. A baby can be born with one or both of these conditions.

The cleft lip can be a partial cleft (microform cleft lip or incomplete cleft lip) or a complete cleft lip.  Either one side (unilateral) or both sides (bilateral) can be affected. The cleft in the palate (roof of the mouth) can also vary from the uvula, the soft palate, the soft and hard palate or the whole palate and the gum line as well.

In addition to repairing the cleft, children need to be monitored as they grow, as they sometimes need additional treatments. Below is a highlight of the common problems, treatments and procedures involved in Comprehensive Cleft Care. Not every child with a cleft lip and palate needs every surgery.  The information is provided to help families understand Comprehensive Cleft Care and how these complicated problems and treatments fit together.

The careful monitoring of kids as they grow allows Dr. Skirko to develop a deep relationship with families. For this reason, deciding on a surgeon to manage your child's cleft is an important decision but shouldn't bring more stress than the surgeries.  We can discuss your child's problems and formulate a care plan that works for your family. 

No matter where your child is in the continuum of Cleft Care, we are available to discuss any concerns you and your family may have.  For detailed information about each of the possible surgeries and management, see the tabs below. 

Prenatal Counseling

3D UltrasoundParents that learn their child has a cleft lip and or palate during pregnancy can have many questions and our team can help get you ready to care for your child with a cleft.  Ultrasounds are more able to diagnose cleft lip prior to delivery and can identify an isolated cleft palate to some degree as well. Prenatal counseling is an option we offer families to help them understand cleft lip and palate and answer all the questions they have.  It is often helpful in taking the mystery out of the problem.

Preparing for the surgery to repair your child's cleft lip is often one of the most stressful times for families.  As facial plastic surgeons, we operate on children day in and day out.  While it is a daily activity for your surgeon, we recognize that it is a major event for any family.  Your surgeon can meet and discuss the surgery to repair the cleft lip and answer any questions you may have. 

Children with cleft lip and palate often need help from many types of providers that will help optimize your child's health and quality of life.  Your surgeon should be the leader of your child's team and help your family navigate through your child's care; both early and long-term. ​

Before your child is born, we can help you understand cleft care, including:

  • Feeding Your Child
  • ​Speech Challenge
  • ​Ear and Hearing Problems
  • ​Dental and Jaw Problems
  • Surgeries Your Child Might Need

There is often a lot of information to absorb, so references like this can be helpful.  Members of the team will help your family understand how to feed your child with a cleft and help you with special bottles they will need.  If your family has any other needs, your surgeon can help you navigate the system and connect you with the needed resources.  

What Sets Us Apart?

Your surgeon can help connect you to the team members and community resources you may need as you and your family are learning to care for your child with a cleft.  Our surgeons are part of the Fetal Team at Banner Diamond Children's Medical Center and are involved in planning, counseling and subsequent care of infants with a wide range of anomalies affecting the head, neck, face or airway. We are experienced in Prenatal Counseling and will help you understand your child's problem and plan to address it.

As Pediatric Facial Plastic & ENT Surgeons, we help many children with complex problems.  Many of our patients have problems that are best managed by a team of experts.  We are experts in helping your family navigate these systems and will be your advocate.

Infant Cleft Lip Care

Feeding and Weight Gain

At your early visit, your surgeon will discuss feeding challenges, strategies and help ensure your child does not have any other feeding problems.  Some infants with a cleft need more help and attention to get the nutrition they need to grow, thrive and heal from their upcoming surgeries. 

While most children with a cleft grow and thrive, some need additional attention and evaluation from infant feeding experts.  These evaluations by your surgeon and other experts will help make sure your child doesn't have breathing problems that limit their feeding problems because they choke and aspirate (milk going into their lungs) while feeding.  Some providers not familiar with the complexities of these feeding issues may not know how to evaluate and address your concerns.  Your surgeon should evaluate your child's breathing & airway and also help ensure your child has the proper evaluation if there is concern for any of these issues. 

What Sets Us Apart?

Our surgeons frequently help manage children with airway, breathing, and swallowing problems.  Some children have medical problems when treated, improve their breathing and eating.  We help these children on a daily basis.  We often work closely with speech and language pathologists and occupational therapists to identify and treat breathing and swallowing problems in infants and older children.  We are experts in this area and often coordinate teams helping the most complex children including many without cleft lip and palate. 

Nasolabial Molding

Many children with cleft lip benefit from improving the severity of the lip and nose deformity before surgery. One option is nasolabial molding. This is a specific type of taping that brings the cleft lip closer together. This often also slowly brings the gum line together (where the teeth will eventually form). This is done early in infancy to narrows the cleft lip and improves the outcome of the cleft lip repair.  The nostril is also adjusted so that it is more rounded. The cartilage in babies is more moldable so reshaping early infancy improves the way the nose looks after the lip is repaired.

What Sets Us Apart?

Our practice focuses exclusively on children with conditions of the face, head, neck or throat.  We often work closely with the cleft team's prosthodontist (the person who makes and adjusts the nasolabial molding device) to help ensure we are improving the lip and underlying upper jaw for the optimal results.  In children that have a more complex problem of the lip and face, we work with the prosthodontist to maximize their outcome by tailoring the nasolabial molding to your child's needs.

Alternatives

While nasolabial molding provides great benefit in most cleft babies, it is time consuming and can be a burden on your family. Especially if you live a distance from Tucson. or this reason, some of families may choose a lip adhesion procedure to help mold your child's face.  In this procedure, the lip on the side of the cleft is brought together without interfering with the tissue that will be used for the definitive lip repair.  This lets your child's lip provide tension on the face to slowly optimize results of the cleft lip repair.  This procedure is more often done in children with wider clefts.  There is a risk of the site breaking down because it is done in children with a wide cleft and is under some tension.  Your surgeon can meet with your family and help choose the best treatment that fit your family's distinct needs.

Tailored Care 

At Diamond Children's, your surgeon treats many children that live a great distance from Tucson.  Families that live long distances from Tucson may have extreme difficulty returning for regular adjustments.  Some of these families may choose a lip adhesion or a taping system to prepare for lip repair.  We can help with these difficult decisions.  If your child needs a lip adhesion and we decide it would be best to consolidate treatments to decrease the surgical burden, we may decide that doing the definite lip and palate can be repaired at the same time.

Timing of nasolabial molding or nasolabial molding Alternatives

The presurgical devices that help optimize your child's outcome have the best chance of working when started in the first few weeks of life.  We often make special arrangements to help design the presurgical plan that will help your child have the best outcome.  Even if the cleft is not wide, reshaping the nose/nostril is often needed to help your child have the best outcome.

 


 

Common Questions:

What if I can't return every week for nasolabial molding adjustments?

​​​​If nasolabial molding isn't working or isn't possible given your situation, your surgeon can discuss the alternatives and help decide on the plan that is right of you and your child.

Does the nasolabial molding device hurt?

Some of the first presurgical devices were pinned to the upper jaw and required anesthesia to place. These devices were found to impair upper jaw and facial growth so they are no longer commonly used.  The current nasolabial molding devices usually do not hurt to place or to wear.  Like anything new, your child may act different while they are getting used to the nasolabial molding. Rarely, the nasolabial molding device causes a 'sore' on the upper jaw or palate.  If this occurs, we will work with the prosthadontist to identify a solution.

Is the nasolabial molding device required for every baby with a cleft?

The nasolabial molding device can be very helpful for wide clefts (to bring the edges of the cleft closer together) and for children with a flattened nose (cleft nasal deformity).  Some babies with a cleft lip do not have these problems and the nasolabial molding is not needed. Most babies with a cleft lip and an asymmetric nose have the best outcome with the nasal part of the nasolabial molding device.  For some children, we only need to help shape the nose/nostril.  Your surgeon will help make this decision. Some babies have medical problems or trouble breathing and we need to monitor their breathing closely with the nasolabial molding in place.  Occasionally we decide against using the nasolabial molding all together.  This is uncommon and your surgeon can help work through any issues that arise.

Primary Cleft Lip and Nose Repair

The cleft lip is usually repaired when a child is 2-3 months old; depending on your child's size and their overall health.  This surgery repairs the gap in the lip that extends into the nose and includes the skin, the muscle of the mouth and the mucosa on the inside of the lip.  The flattening of the nose on the side of the cleft is repaired at same time the lip is repaired. 

There are a number of techniques for repairing the cleft lip.  The surgery is tailored to your child's cleft.  The procedure is slightly different if your child has a bilateral cleft lip (cleft going into both nostrils) or a unilateral cleft lip (cleft going into one nostril). 

Unilateral Cleft Lip Repair

Children with a unilateral cleft lip (a gap in the lip going into one nostril) need a surgery to rotate the central side of the lip down. There is less tissue and this elongates the shorter central side of the cleft lip.  The lateral (outside) of the cleft lip is advanced across the defect.  The muscle is brought together to recreate the circle of muscle around the mouth.

There are many ways of accomplishing this. Dr. Skirko hides the scars in the subtle natural lines of the lip and nose so that is mirrors the non-cleft side. This camouflages the scar in natural lines. Most older techniques have scars that cross the midline and violate the central lip (philtral column). Scars here draw your attention more. Some have incisions in areas that causes problematic scarring. Dr. Skirko uses a newer technique was developed to follow the natural lines and hides the scars in these naturally occurring contours. This technique is called the anatomic subunit technique.  While there is no 'Gold Standard,' having a surgeon comfortable with several techniques will allow them to tailor the repair to your child's lip defect.

What Sets Us Apart?

The principles of reconstruction on the face often utilize hiding scars in natural contours to improve the final result.  Our surgeons are well versed in these techniques and can often utilize cleft lip repair that is based on these natural contours.  While the long-term results comparing these newer techniques to older 'cut as you go' techniques haven't yet been reported, families and teams using these newer techniques are often very pleased with the result at the lip and just inside the nose.  This repair can only be performed on children with a unilateral cleft.  Your surgeon can discuss the specifics of your child's repair during your visit.  

Our surgeons have extensive training and experience in cleft lip repair as well as the removal of masses from the lips.  Our surgeons focus their work on children with conditions of the face, head and neck.  This provides us with unique training and experiences.  Not only are we experts in making the face, nose and throat look normal, but we are also experts in helping optimize the function of these critical areas.

In addition to extensive training, our surgeons are often asked to repair lip scars.  Performing these lip scar revisions has helped us have a deep understanding of the subtleties in primary cleft lip repair to avoid these scarring problems. With these experiences, we continue to refine portions of cleft lip repair to optimize your child's outcome.

Bilateral Cleft Lip Repair

For a bilateral cleft lip, the lip skin in the center of your child's face does not have muscle.  The muscle from the two sides is stretched across under the central skin.  The skin on the central lip will make up the center of your child's new lip.  The bone behind the central lip (where your child's front teeth will come in later) is sometimes pushed out too far.  Nasolabial molding is helpful in pulling this bone back into position and making the lip repair more successful.  Part of the lip repair involves reshaping the nose, both the way it looks on the outside as well as just inside the nose and how the nose works. 

What Sets Us Apart?

Our surgeons have extensive training and experience in cleft lip repair as well as the removal of masses from the lips.  Our surgeons focus their work on children with conditions of the face, head and neck.  This provides us with unique training and experiences.  Not only are we experts in making the face, nose and throat look normal, but we are also experts in helping optimize the function of these critical areas.

Families often seek our help in repairing their child's lip scars.  Performing these lip scar revisions helps us have a deep understanding of the subtleties in primary cleft lip repair to avoid these scarring problems. We continue to refine portions of cleft lip repair to optimize your child's outcome.

Primary Cleft Rhinoplasty

Infants with a cleft lip and varying degrees of abnormality with the way their nose looks.  Often the cartilage that keeps the nose 'springing open' is slightly smaller than normal, is often positioned abnormally, and is often flattened. Addressing only the cleft in the lip will leave your child with asymmetry of nose until it is surgically repaired. The repair of the cleft lip can allow your surgeon access to the nasal space.  Using minimally invasive techniques through the lip incisions, your surgeon will reposition the nasal cartilage in a more normal position.  The skin and cartilage are usually held in their new position with sutures that may be seen on the side your child’s nose. Sutures often are needed on the side of the nose as well.  The suture will either be dissolvable or will have a small piece of gauze 'bolster.'  The amount of repair required for the nose depends on the deformity.

What Sets Us Apart?

Infants have to breathe through their nose and disorders affecting the nasal airway are serious in babies.  For example, an infant will breathe through their nose and eat through their mouth at the same time.  Sometimes these disorders are less serious but don't allow a baby to feed easily.  Other infants have growths inside of their nose and sinuses that need to be removed and depending on the growth may need reconstruction

Our surgeons diagnose and manage these problems regularly.  We have an in-depth understanding of nasal anatomy and the function of the nasal passages.  We utilize this experience at the time of the initial repair, but also as children grow and develop problems with the inside or outside of their nose.

Tailored Care

Some children need additional small modification of their nasal procedure to optimize their nose.  Sometimes this involves limited repositioning of the septum.  Sometimes this involved different techniques to stabilize the nasal cartilage in a normal position.  Your surgeon will assess your child's cleft and review the plan with you so that any questions you have can be answered. 

What To Expect

  • When you meet your surgeon to discuss surgery, you will receive a handout that details what to expect as well as home care your child will need.  Reviewing this before surgery with your surgeon and our clinic nurses will make the time after surgery less stressful.
  • For a week or two after surgery, your child will likely need a little extra care and attention.  You shouldn't be concerned about 'spoiling' your child while they are recovering.  It is ok to help your child through their recovery with extra holding and comforting.
  • Children stay in the hospital one or two nights depending on how well they recover from surgery. 
  • Your child will have an IV that will be used to give your child fluids (to keep them hydrated) and IV pain meds if the pain medications they take by mouth aren't enough.
  • They may have small flexible stents in their nose to help with healing. 
  • Your child's lip and nose will likely be swollen.
  • Most if not all of the sutures will be dissolvable.  In certain circumstances, your surgeon may feel sutures that need to be removed will be a better result.  These sutures are usually removed in clinic.
  • Your child will receive pain medication and this will be adjusted to ensure their pain is well controlled.
  • Your child will be closely monitored for pain control, breathing and how much they are eating/drinking.
  • Your child will usually wear 'Arm Straighteners' that help prevent them from accidently hurting themselves while they are healing

 


 

Common Questions

How will I feel about how my child looks after surgery?

After surgery, your child will look different.  This is often very emotional time.  Some parents miss the 'big smile' of their child with a cleft, but they are excited to see their child's new face.  The nurses and staff at Diamond Children's will help you through this exciting time.

Are there restriction on how my child can eat?

Our surgeons don't put restrictions on how you child eats or drinks.  Your child can use whatever bottle or cup they used before surgery.  Problems with healing are very uncommon and these restrictions don't seem to decrease the likelihood of having a problem.  Most children are able to drink and eat soon after surgery, but some kids refuse.  Your nurse will work to figure out what your child needs to help them eat.

Will my child be able to drink after the cleft lip surgery?

Most children do well eating and drinking after cleft lip surgery.  Their lip and face is soar but it is uncommon to have enough pain to prevent them from drinking.  Sometimes babies need stronger pain medications to make them comfortable.  We will monitor your baby closely to ensure they have the pain medications they need.

If your child needs stronger pain medications, they might get constipated.  If this happens, usually a couple ounces of apple or pear juice helps to get things moving.  Check with your surgeon to make sure this is ok for your baby.

Do I need to clean out the nasal stents if my surgeon chooses to use them?

Infants have to breathe through their noses.  If the nose stents become clogged, they may have trouble breathing and eating.  Infants breath faster than we do, so they need to coordinate breathing and eating.  If they are having trouble breathing, difficulties with feeding is sometimes one of the first things we notice.  Sometimes fixing this is as simple as putting saline (salt water) drops in the nose.  If your child's stents are starting to clog, you can use saline with every diaper change to thin the secretion.  Other times the stents need to be replaced or cleaned out.  If your baby is having trouble breathing, you should call your provider.

We are starting to use newer nasal stents that stay in on their own and can be removed for cleaning at home.  Your surgeon can discuss whether these are right for your child.

Palate Repair in Patient with Cleft Lip and Palate

The cleft in the lip often extending into the gum and the palate.  If the cleft extends into the palate, it needs to be repaired with a surgery that brings the tissue together and realigns the soft palate muscles.  The procedure is slightly different in children with a cleft of the palate without a cleft lip. 

The hard palate (roof of the mouth) is made of gingiva (similar to the tissue that surrounds your child's teeth) while the soft palate (further back and next to the dangly uvula) has mucosa and muscle.  When there is a cleft in the palate, the muscles of the soft palate do not run in the correct direction.  Instead of running across the palate they run front to back.  Moving these muscles so they travel across the palate is important to help the palate function as your child learns to talk. Depending on how wide the gap in your child's palate is, they may need different kinds of palate surgery. 

What Sets Us Apart?

Our surgeons often operate on the palate, mouth and throat for a variety of reasons.  From removing tumors, improving breathing, improving speech to cleft palate repair, your surgeons have in-depth understanding of the form and function of the palate and throat. 

Our surgeons focus their work on children with conditions of the face, head, throat and neck.  This provides us with unique training and experiences.  Not only are we experts in making the face, nose and throat look normal, but we are also experts in diagnosing problems and optimizing the function of these critical areas. 

Your surgeons will work with you to determine the which of the following plans for closing your child's cleft palate.  

Palate Repair

During palate repair, the tissue on the hard palate is freed and brought together in the middle. On the soft palate, the muscle is re-oriented so it runs across the palate in the normal orientation. This is usually done with a special procedure, the Furlow palatoplasty or double z-plasty.  This procedure lengthens the soft palate and moves the muscles so that they are running across the palate rather than running front to back. The rest of the soft palate and uvula (dangly part of the palate) is brought together to create a single uvula. Our studies have shown (along with others), that the z-plasty lowers the risk of later speech problems.

If the gap in the soft palate is wide, your child may need a surgery that brings the tissue together in a straight line in the middle while rotating the tissue across the soft palate.

Tailored Care

Your surgeons will work with you to decide which type of palate surgery is best for your child.  Sometimes we don’t know if a z-plasty will be possible until during the surgery. We will involve you in the decision making process. 

What To Expect

  • When you meet your surgeons to discuss surgery, you will receive a handout that details what to expect as well as home care your child will need.  Reviewing this before surgery with your surgeons and our clinic nurses will make the time after surgery less stressful.
  • For a week or two after surgery, your child will likely need a little extra care and attention.  You shouldn't be concerned about 'spoiling' your child while they are recovering.  It is ok to help your child through their recovery with extra holding and comforting.
  • Children stay in the hospital one or two nights depending on how well they recover from surgery. 
  • Your child will have a suture that is loosely tied to their tongue.  The end is often taped to the cheek.  This is used in the case of an emergency to help your child breath.  This is usually removed the evening of surgery.
  • Your child will receive pain medication and this will be adjusted to ensure their pain is well controlled.
  • Your child will be closely monitored for pain control, breathing and how much they are eating/drinking.
  • Your child will wear 'Arm Straighteners' that help prevent them from accidently hurting themselves while they are healing.
  • The nursing staff at Diamond Children’s care for many children that have these types of surgeries.  They will provide you with many pointers in addition to compassionate post operative care.

 


 

Common Questions

Are there restriction on how my child can eat and drink?

Our surgeons don't put restrictions on how you child eats or drinks.  Problems with healing are very uncommon and these restrictions don't seem to decrease the likelihood of having a problem.

Will my child be able to drink after the palate surgery?

Most children do well eating and drinking after palate surgery.  They have a sore throat and swallowing feels different to them.  They know how to swallow still and can do it, we often just have to figure out what they want and need.  After your child wakes up from anesthesia, you can begin giving them fluids and soft foods.  Some children do best drinking from the bottle or cup they used before surgery.  Others may need to be fed with a syringe or similar device while they recover.  While some children do best with liquids, others do better with soft solid foods at first.  Your child will gradually return to their usual routine.  Most children go home the day after surgery, but some need to stay an extra day or two.

How do I take care of the surgical site in the mouth?

The inside of the mouth will heal without any specific care.  The most important thing is to protect the area while it heals.  This means keeping your child from sticking things in their mouth.  The stitches in the mouth will dissolve and do not need to be removed.  The dissolvable stitches can be swallowed or spit out.  Your child might also have foul breath while they heal.  This is all normal and will go away once the palate has healed. 

Will my child have breathing problems after palate surgery?

While we will monitor your child closely for breathing problems after cleft palate repair, it is unlikely that he/she will have a problem.  Sometimes the tongue is swollen and medicine is needed to help reduce the swelling.

Alveolar Bone Graft

The cleft in the lip often extending into the gum and the palate.  If the cleft extends into the palate, it needs to be repaired with a surgery that brings the tissue together and realigns the soft palate muscles.  The procedure is slightly different in children with a cleft of the palate without a cleft lip.

As your child's face grows, the gum line (also known as the alveolar ridge) may not need to be moved by an orthodontist with a palatal expansion devices.  After your child's dentist and orthodontist ensures their gum lines are in the proper place, a graft of bone is usually needed in the gum line to allow their teeth to be moved into the correct location.  When we do this surgery, we also close the hole between the mouth and nose. 

While there are many options of graft material for the alveolar ridge, often the best choice is to use hip bone. Newer options for harvesting the bone with minimally invasive technique decreases the discomfort from the hip harvest. For certain patients, a synthetic product (such as bone morphogenic protein) to stimulate your child's body to create their own bone. Your surgeon can discuss the details of this decision in person. Your surgeon will explain the risk and expectations from this surgery, if your child will need to have the hip graft.

Tailored Care

When the protein is stimulating your child's body to produce more bone, it also releases inflammatory mediators in the tissue.  This causes swelling that is slower to resolve than the usual swelling after surgery (because the protein is still stimulating bone growth).  When this product was used in spine surgery, this swelling caused the airway at the back of the throat to become narrow and patients had breathing problems.  Fortunately, if the upper lip swells this doesn't cause breathing problems but it can make your child uncomfortable.  Your Pediatric Facial Plastic & ENT Surgeon can discuss the other risks and benefits with your family to decide which treatment is right for your child.

What Sets Us Apart?

Your surgeon will work with you to decide which option is best for your child and your family.  The synthetic product we use has been used for many years now and has been shown to have excellent results.  There are some theoretic risks (things we worry about but have not been shown to occur) that your surgeon can discuss with you.

What To Expect:

  • Younger children often stay in the hospital overnight after this surgery to make sure their pain is controlled.  Older children getting an alveolar bone graft without hip bone harvest can often go home the evening of surgery.
  • The sutures above the gum line are dissolvable. 
  • Your child will use an antiseptic mouth wash for a week to help prevent infection.
  • Your child will take an oral antibiotic to help prevent an infection in the graft to help ensure it 'takes.'
  • If you and your surgeon decide on the synthetic product (bone morphogenic protein), the upper lip and middle of the face will slowly become swollen for a week or two.  The swelling is related to the way the protein stimulates bone growth and sometime makes children more uncomfortable. 
  • Your child will receive pain medication and this will be adjusted to ensure their pain is well controlled.
  • Your child will be closely monitored for pain control, breathing and how much they are eating/drinking.  Usually children do well after surgery.
  • Younger children may wear 'Arm Straighteners' that help prevent them from accidently hurting themselves while they are healing; this depends on their age
  • The nursing staff at Diamond Children’s care for many children that have these types of surgeries.  They will provide you with many pointers in addition to compassionate post operative care.

 


 

Common Questions

Are there restriction on how my child can eat and drink?

Our surgeons don't put restrictions on how you child eats or drinks.  Problems with healing are very uncommon and these restrictions don't seem to decrease the likelihood of having a problem.

Will my child be able to eat and drink after their surgery?

Most children do well eating and drinking after jaw surgery.  They have a sore jaw and will want to avoid certain types of foods.  We will work to find the best pain control for your child after surgery. 

Will my child have breathing problems after jaw surgery?

While we will monitor your child closely for breathing problems after jaw surgery, it is unlikely that he/she will have a problem.  We will also monitor heart rate.

Will my child's teeth be numb after surgery?

Temporary numbness to the upper teeth can happen after surgery but is usually temporary.

Ears, Tubes and Hearing

“Ears Problems and Hearing Loss”

Many children with a cleft palate have problems with their ears that can go unnoticed. They are more likely to have problems with build up of fluid behind the ear drum (or Eustachian tube dysfunction) as well as hearing loss.

The Eustachian tube drains the mucous that cleans the space behind the ear drum (the middle ear). This tube drains the fluid to the back of the nose right next to the cleft palate. The palate muscles are involved in opening the Eustachian tube.

When the Eustachian tube doesn’t function properly it can result in:

  • Fluid Accumulation: Fluid can build up in the middle ear (serous otitis media). This fluid build-up can make the middle ear an ideal environment for the growth of bacteria, leading to recurrent ear infections, known as acute otitis media.
  • Pressure Imbalance: Many children with a cleft palate have compromised Eustachian tube function, leading to an imbalance in middle ear pressure. This pressure imbalance can cause discomfort, pain, and even affect hearing.
  • Risk of Hearing Loss: The persistence of Eustachian tube dysfunction and associated middle ear infections can lead to conductive hearing loss, wherein sound waves are unable to pass from the outer to the inner ear effectively. This can impact the child's ability to hear and understand sounds, potentially affecting their speech and language development.

Management and treatment of ear problems and hearing loss in children with cleft palates often involve a multidisciplinary approach with your child’s Otolaryngologist, Audiologist, as well as Speech Pathologist. The ears and hearing are important, so we monitor for this between the newborn hearing screening (where the fluid might not have built up yet) and palate repair. Children with a cleft palate sometimes have other types of hearing loss. Your Otolaryngologist and Audiologist will help understand if this is a problem as well.

Management of Eustachian tube dysfunction in kids with a cleft palate includes:

  • Surgical Intervention: Ear tube placement (tympanostomy tubes) may be recommended to help drain fluid from the middle ear and reduce the frequency of infections. Additionally, surgical repair of the cleft palate may improve Eustachian tube function. Up to 95 percent of kids with a cleft palate will need ear tubes and many need a second or third set when the first set falls out.
  • Regular Monitoring: Regular check-ups with an otolaryngologist and audiologist are crucial to monitor the child's ear health and hearing abilities. Timely identification and management of any issues can prevent long-term complications.
  • Speech Therapy: Children with cleft palates may benefit from speech therapy to improve their articulation and communication skills. If hearing loss has affected speech development, specific interventions may be necessary to facilitate language acquisition.

Overall, early detection and appropriate management of ear problems and hearing loss are vital in ensuring optimal development and quality of life for children with cleft palates.