Repair of Cleft Lip and Cleft Palate
Guest: Dr. Christopher Discolo – Otolaryngology - Head & Neck
Host: Dr. Linda Austin – Psychiatry
Linda Austin: I’m Dr. Linda Austin. I’m interviewing Dr. Christopher Discolo who
is Assistant Professor of Ear, Nose & Throat here at the Medical University
of South Carolina. Dr. Discolo, you have
such an important specialty, the surgical repair of children who come into the
world with a cleft lip or cleft palate, and we talked in an earlier podcast
about what that is. Let’s imagine, now,
that you’re talking to a parent who has just had an ultrasound, during
pregnancy, and they’ve gotten the news that their child, their beautiful little
boy or little girl, will come into the world with cleft lip or cleft
palate. What kinds of things would you
say to that parent and what should they start thinking about?
Christopher Discolo: Well, I think it
depends if the child has simply cleft lip or cleft lip with cleft palate. Children
who are born with cleft palate can expect to have some feeding problems shortly
after birth. And here at MUSC, with our
Cleft and Craniofacial
Center [Craniofacial Anomalies and Cleft Palate Center], we have speech and
language pathologists who are extremely dedicated to the care of these
children. So, we would have the families
meet with our Cleft and Craniofacial team prior to the birth of the baby so
that the family can be fully informed and know completely what to expect once
their child is born.
Austin: And, what should they
expect? What are some of the basics that
they will be told when they go through that process?
Dr. Christopher Discolo: For children with cleft palate, one of the
major factors is that they may not be able to breastfeed effectively and,
obviously, that’s a very important concern for new mothers. The fact is that with the hole in the roof of
the mouth, very often the babies cannot form an adequate latch onto the
mother’s breast, and that can be quite frustrating for the baby and the
parents, so we provide a lot of counseling in terms of proper techniques for
Austin: And, in that situation, then, a
mother might anticipate the possibility of, let’s say, pumping breast milk, if
she chooses to do so. Is that
Dr. Christopher Discolo: That’s correct, and we certainly encourage
that breast milk is the best form of nutrition for the baby. The mother may just not be able to deliver it
directly from the breast. She may need
to pump it and give it via a specialized bottle for babies with cleft palate.
Austin: And so, then, Dad gets to be involved in that process, in the feeding of the baby.
Dr. Christopher Discolo: Yes.
Linda Austin: Okay. So, feeding is one. At what age might an infant have their first
surgery for cleft lip or cleft palate?
Christopher Discolo: Generally, the
cleft lip is repaired first, usually at about three months of age. Cleft palate is repaired a little bit later,
generally when the children are about 10-12 months of age.
Linda Austin: And why is that? Why is it done in two stages?
Christopher Discolo: Well, the cleft lip
is repaired early on, once the baby is old enough to undergo safe general
anesthesia. The timing of cleft palate
repair is somewhat controversial. Some
people will advocate fixing the cleft palate at a very young age. Most surgeons, however, choose to fix it at
about 10 months of age, right before the development of speech and language.
Linda Austin: How extensive is that
surgery? I’m sure it varies, depending
on how extensive the anatomy that you’re trying to repair is. But, just to give a parent who is listening
to this podcast some idea of what to expect, how do you describe that to them?
Discolo: Well, in general, both
operations are fairly major operations in that they take a few hours to
complete. The cleft lip surgery is
relatively well tolerated by the children.
Most children only need a one-night stay in the hospital after
surgery. They can resume feeding as soon
as they wake up from anesthesia. But it
takes, probably, about one to two weeks to recover fully from the operation.
cleft palate surgery, on the other hand, is a more painful operation. Children are generally in the hospital for
two to four days after surgery, while we wait for them to become comfortable
enough to start feeding well again, before we can send them home.
Linda Austin: How do you help a child
with that painful situation?
Christopher Discolo: We provide pain
medication after surgery so the children are kept comfortable.
Linda Austin: So, you’re saying, it would be painful if they did not stay in
the hospital, but you keep them in the hospital to keep them comfortable, to keep
them fed, to keep them hydrated?
Christopher Discolo: That’s
correct. For the first 24-48 hours after
surgery, it would be difficult for the families to manage these children at
home, so we keep them in the hospital and keep their pain under good control
and start them back on their proper nutrition regimen.
Linda Austin: So, there are those two
surgical procedures. How about
afterwards, as a child matures, are there further procedures after that?
Christopher Discolo: There very often
are. Children with cleft lip will very
often have some abnormality of their nose, which needs to be fixed as they get
older. Generally, one operation can be
done during childhood. But, very often
when children reach their teen years and reach the end of their facial growth,
they generally receive a definitive rhinoplasty or nose job at that time.
with cleft palate will very often have a cleft that runs through their gum line
where their teeth erupt. This is not
fixed at the time of the initial cleft palate repair, but is fixed when they’re
about five to six years of age, using a bone graft from the hip. So, that’s another pretty big operation that
these children undergo a little later in life.
Linda Austin: And how long does that surgery
Christopher Discolo: That surgery takes
about one to two hours as well.
Linda Austin: Well, that’s not so
long. I mean, that’s not like, you know,
a five or six hour operation, for example.
Christopher Discolo: No, the surgery
itself is pretty short, but that’s a pretty decent recovery for the kids also.
Linda Austin: You mentioned that cleft
lip and cleft palate, in the earlier podcast, are pretty common. Just how common is it? What percent of babies born have cleft lip/cleft
Christopher Discolo: The overall
incidence is about 1 in every 1,000 births.
Linda Austin: So, it’s quite
common. So, this must be a very common
procedure that we do all the time here at MUSC, is that correct?
Christopher Discolo: That’s
correct. Our Cleft and Craniofacial team
here performs all of these operations regularly. On average, I’d say we perform about 30-40 of
these types of operations per year here at MUSC.
Linda Austin: So, for you, then, it’s a
very routine procedure, something that you have performed many, many times
before. And, I think it’s really
important to underline what great results parents, ultimately, can expect,
that, you know, it’s really hard when your little baby has to go through an
operation. There’s no denying that. But, these are safe procedures. These are effective procedures. And, their child will eventually have a very
lovely result from this.
Christopher Discolo: That’s
correct. And the overall chance of the
child to have a very normal life is very high.
Linda Austin: Good news.
Christopher Discolo: Very good news.
Linda Austin: Dr. Discolo, thanks so
much for talking with us today.
Christopher Discolo: Thank you.
If you have any questions about the services
or programs offered at the Medical University of South
Carolina or if you would like to schedule an
appointment with one of our physicians, please call MUSC Health
Connection: (843) 792-1414.