Corrective surgery is available in Savannah to repair cleft birth defect

Before and after photos of a cleft lip corrective surgery performed by Dr. Ambrose at St. Joseph's/Candler

Cleft lip and palate occur in 1 in 500 to 1,000 births

Expecting parents have a lot on their minds with the pending birth of a baby boy or girl. Among the top concerns is a healthy newborn.

Unfortunately, there are conditions that some infants are born with that may need to be addressed early in life. A common abnormality is cleft of the lip, palate or both.

The good news is clefts are treatable and can be corrected through surgery within the first few months to a year of life. Dr. Stephanie Ambrose is a pediatric otolaryngologist with Georgia Ear, Nose & Throat Specialists. She is the region’s only fellowship-trained pediatric ENT who performs cleft lip and cleft palate corrective surgery. The above photo is before and after a recent surgery performed by Dr. Ambrose.

“It’s a really rewarding procedure to do because there are functional deficits, such as speech and swallowing, that are addressed by fixing clefts,” Dr. Ambrose says. “It’s nice to eat like everyone else and speak like everyone else and overall improve the quality of life for the child.”

What is a cleft?

A cleft occurs when a baby is born with an opening in the lip or roof of the mouth (palate). Clefts form during the first six to 10 weeks of pregnancy when the soft tissues and bones of the face, jaw and mouth fail to come together normally, says Dr. Ambrose. Clefts can involve the lip alone, the lip and palate or the palate alone. They can vary in size and extent and can involve one or both sides of the mouth, Dr. Ambrose says.

Cleft lip and palate occur in 1 in 500 to 1,000 births. An estimated 200,000 babies are born with a cleft lip, palate or both each year in the United States.

Usually, the cleft lip and palate are found by the pediatrician when a baby is born. Some defects may be seen on a prenatal ultrasound. Children born with cleft lip and/or palate may have problems with breathing, feeding, hearing and speech.

Babies with cleft palate may require a special bottle or nipple and the help of a lactation consultant or speech therapist to help with feeding and swallowing, Dr. Ambrose says. She recommends babies with feeding issues have regular check-ups with their pediatrician to make sure they are gaining proper weight.

Children with cleft palate also are at risk of building up fluid in the ear, resulting in hearing loss or making them prone to ear infections. Children with cleft palate usually require ear tubes to drain the fluid and improve hearing, says Dr. Ambrose.

“It’s a condition that affects multiple facets – aesthetics and function in breathing, swallowing, speech – so in that sense, it is something that we would be intimately involved in with that child for a period of time to repair the defect and improve quality of life,” Dr. Ambrose says. “A multi-disciplinary collaboration is an important mechanism in treatment and involves myself, a pediatrician and often times a speech therapist, lactation specialists and possibly even dentists down the road.”

The cause of a cleft is not always known, Dr. Ambrose says. Many develop due to a combination of genetic and environmental factors. There are more than 400 genes linked to formation of cleft lip and palate. Some environmental factors associated with cleft include medications, deficiency in folic acid and cigarette, drug or alcohol use during pregnancy.

How corrective surgery can help

Cleft lip and palate are treatable. A cleft lip is usually surgically repaired around 3 months of age. The procedure requires general anesthesia and usually an overnight stay, Dr. Ambrose says. During the procedure, the soft tissues and muscles of the lip are closed, leaving a small scar from the upper lip to the nose.

A cleft palate is typically repaired around 12 months of age. The tissues and muscles of the soft palate are brought together to close the cleft, Dr. Ambrose describes. This procedure requires general anesthesia and usually a one to three night hospital stay. Dr. Ambrose adds that more surgeries may be needed as children grow older to improve speech, improve the appearance of the nose or to address dental issues.

“The decision to close the lip or palate is based on symptoms and deficits, but I don’t find there are many parents that have opted not to have the surgery,” Dr. Ambrose says. “Having a cleft is not painful itself, but it does affect other functionalities especially speech and swallowing.”

Dr. Ambrose assures parents corrective surgery is performed when the child is at proper development to handle surgery. For cleft palate surgery, it is best if the infant is off the bottle to prevent negative pressure from sucking in order for the palate to heal. She recommends spoutless sippy cups, spoons or syringes for feeding following corrective surgery.

A child may also be required to wear special sleeves or braces to prevent them from sticking their hands in their mouth or lip. The expected recovery time of cleft corrective surgery is two to three weeks.

Dr. Ambrose meets with families typically following a pediatrician referral; however, you can call to make an appointment if you are concerned about a cleft. Dr. Ambrose will discuss with families what to expect and a potential timeline of treatment. She also advises parents on what to monitor until the infant is ready for surgery.

If you’d like to schedule an appointment with Dr. Ambrose, you can call Georgia Ear, Nose & Throat Specialists at 912-356-1515 or request an appointment online.