Cleft Lip & Palate surgery in el paso tx

Top Pediatric Facial Surgeons in West Texas

Are Cleft Palates Common?

Cleft lip and palate is the most common facial deformity (1:700 live births). Our region is particularly vulnerable due to a couple of prevalent factors: nutritional deficiencies and large Latino and Native American populations which are statistically more vulnerable to cleft lip and palate deformities.

What Causes Cleft Palates in Newborns?

The etiology of cleft lip and palate is multifactorial and has been associated with genetic determination, teratogenic drugs, nutritional deficiencies, amniotic banding, chemical exposures, maternal hypoxia, and radiation. Most clefts in families are sporadic, however, if 1 parent has a cleft there is a 4-6% chance that their baby will also have a cleft. Interestingly, boys are twice as likely to have a cleft lip (with or without palatal involvement) and girls are more likely to have an isolated cleft palate only.

Are Cleft Palates Syndromic?

If an isolated cleft palate is present there is approximately a 50% chance that the baby will have an associated syndrome. This is in contrast to a cleft lip patient (with or without palatal involvement) which is only likely to have an associated syndrome in approximately 10% of the cases. In patients with an isolated cleft palate there should be a lower threshold for a thorough work-up if the patient is not progressing as expected.

The care your child needs is in El Paso, TX.


Contact us today to meet David M. Yates, DMD, MD, FACS


East El Paso Office
East El Paso Office Phone Number 915-504-6880
    Book a
Consultation
West El Paso Office
West El Paso Office Phone Number 915-833-2969 

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When Can a Child Have Cleft Palate Surgery?

(Table 1)

A 3-column table describing the timeline for cleft palate surgery typesThe timing of cleft surgery historically has been extremely controversial. However, of late, national recommendations based on research have helped to standardize cleft care.  If one operates too early the patient will suffer growth restrictions that will likely require additional future surgeries to correct. However, early surgery may still be indicated secondary to functional or psychosocial concerns.

What Are Signs of a Cleft Palate?

Cleft care is complicated – these kids are likely to fall through the cracks and all too often may only have limited exposure to an ACPA approved Cleft and Craniofacial Team. It is essential that they be plugged into a Cleft or Craniofacial Team.

Common problems kids with cleft lip and palates may experience:

  • Does their speech sound appropriate? Are they having difficulties in school? (psychosocial? hearing related?)
  • Are they growing their hair out to cover their face?
  • Are their teeth appropriate or do they suffer from dental disease?
  • Are they experiencing sleep apnea?
  • Are they socially isolated or thriving in their school environment?
  • Do they still have an obvious deformity? Do liquids or food come out of their nose when they eat? (Table 2)

a table listing problems associated with cleft palates

How Soon Should a Child Be Seen for a Cleft Palate?

It is CRITICAL that these kids are involved in an ACPA approved Cleft and Craniofacial Team. Our Cleft and Craniofacial Team is composed of individuals who have dedicated their practices specifically to Cleft and/or Craniofacial care. Our El Paso ACPA approved team includes Cleft and Craniofacial Surgeons, Ear Nose and Throat Surgeons, Oral and Maxillofacial Surgeons, Neurosurgeons, Craniofacial Orthodontist, Pediatric Dentists specializing in Cleft/Craniofacial deformities, Speech and Language Pathologist, Occupational Therapist, Nutritionist/Dieticians, Nursing Coordinators, and Social Workers.

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When Should Primary Cleft Lip Deformity be Repaired?

The primary cleft lip deformity may be complete or incomplete, and is best repaired between 3-6 months of age. If complete, Nasoalveolar Molding or (NAM) is extremely helpful in decreasing the size of the cleft defect prior to performing surgery. We are very fortunate to have a nationally known NAM provider, Dr Holguin DDS, who we closely work with, to help get our cleft babies ready for surgery.

How is a Primary Cleft Palate Deformity Surgery Performed?

The palate is critical for appropriate speech and aids in feeding. It is important to perform the palatal repair between 10-18 months of age to ensure that appropriate speech development can occur. There are different types of palatal repairs, however, Dr. Yates prefers the furlow palatoplasty which is expected to increase length and aid in speech.

When Should a Cleft Alveolus (Cleft Bone Graft) Surgery be Done?

The Alveolar Cleft Bone Graft surgery is usually performed between the ages of 6-12 years of age. The exact timing is determined secondary to expected tooth eruption. After the cleft lip and cleft palate are repaired, it is normal for there to be a small fistula (or hole) in the area of the teeth between the nose and the mouth. This area is not repaired until the bone graft if performed. This surgery used to always require that bone be taken from the child’s hip and placed in the area where the teeth will come in. However, now we no longer need to do this because equivalent results are obtained using a combination of cadaver bone and rhBMP (bone morphogenetic protein). The cadaver bone acts as a scaffold and the rhBMP encourages the bodies own stem cells to turn into bone cells and produce bone in the area where the cleft previously was present.

What is Cleft Lip Revision?

It is common as the repaired lip grows for slight widening or unfavorable healing to occur resulting in the need for small minor cosmetic touch-ups on the lip. If needed, this is usually done between the ages of 5-10, but may be performed into adulthood if needed.

What is Cleft Orthognathic (Jaw) Surgery?

In approximately 50% of kids with cleft lip and palate the upper jaw will not grow as quickly or as far as the lower jaw. This results with a sunken in appearance to the middle portion of the face, as well as, an underbite. In these kids doing jaw surgery can truly be lifechanging. Our team plans the cases using medical modelling (computer generated models) which exactly represent the childs’ occlusion and bone structure. From these models we plan the surgery to create the most symmetric and appropriate result for our patients. Usually this is performed once skeletal growth is near complete (late teens).

The care your child needs is in El Paso, TX.


Contact us today to meet David M. Yates, DMD, MD, FACS


East El Paso Office
East El Paso Office Phone Number 915-504-6880
    Book a
Consultation
West El Paso Office
West El Paso Office Phone Number 915-833-2969 

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