Chapter
1:
Late
Cleft Treatment
|
Chapter
1: |
|
Clefts of the Lip and Palate
Late Cleft Treatment
Clefts of the Lip and Palate
|
Late Cleft
Treatment:
The Craniofacial Center can also help those
individuals that have grown up without access to a comprehensive, coordinated
team approach. For adults with speech problems, the previously mentioned
pharyngeal flap, combined with an intensive regimen of speech therapy,
can produce significant improvements. Orthognatic surgery is available
to patients with deformities of the jaws to improve their appearance as
well as to correct dental occlusion. For soft tissue revision of a severely
tightened or notched upper lip, an Abbe flap is the surgical option. This
procedure is usually indicated in bilateral cleft patients who have a
short or deficient columella and a tightened upper lip. This operation
can add fullness to the upper lip as well as lengthen the columella. A
number of additional surgical therapies, similar to the ones described,
are available to patients who desire further improvements.
Hearing: Children with cleft palate have a higher incidence of hearing problems. The Eustachian tube connects the middle ear space to the back of the throat. It normally opens and shuts to relieve pressure that builds up behind the ear drum. If the Eustachian tube does not open, then the pressure increases until mucus or "fluid" accumulates behind the eardrum. The muscles responsible for opening the Eustachian tube do not function as well in children with cleft palates resulting in more frequent problems with fluid, otitis media and ear infections which can be very painful. Because of this problem, it is important to have the infant's hearing tested during the first few months. If hearing is impaired by fluid buildup or unequal pressure, it may be necessary for the otolaryngologist to place pressure equalizing (PE) tubes. Tubes are often placed at the time of the lip or palate surgery. It is crucial that children with cleft palates have regular hearing tests to monitor middle ear problems that could alter the development of normal hearing as well as speech. As the child grows, the frequency of ear infections and fluid in the ears seem to decrease. Speech: Speech development in children with cleft lip only should be normal. The unrepaired cleft palate causes speech to sound hypernasal because air passes through the nose while talking. Most speech sounds require the nose to be closed off from the mouth. Cleft palate surgery usually remedies the problem, but speech therapy is still recommended. Approximately 20-30 percent of cleft palate patients will have velopharyngeal incompetence or hypernasal speech after surgery, and may require a pharyngeal flap to correct it around the age of 4-5 years. Dental: Clefts of the palate generally have an effect on dental development. In the area of the cleft, teeth often erupt in a crooked position with extra teeth or missing teeth being common in the cleft area. Radiographs are often taken to determine the exact position of the teeth. Dental problems have an effect on speech, chewing, appearance and frequently require orthodontic treatment. Early orthodontic intervention may require a palatal expansion device with further alignment of the dental arches. Later treatment after the primary teeth have erupted can begin at 10-12 years of age. Orthognathic surgery may be indicated if a malocclusion develops due to abnormal growth of the maxilla.
The Tennessee Craniofacial
Center, part of the Erlanger Health System, is located in Chattanooga,
Tennessee. The Center, led Larry A. Sargent, M.D., specializes in the
evaluation and treatment of patients of all ages with craniofacial deformities.
Location:
975 East Third Street. Chattanooga, Tennessee 37403
|