Surgical Repair of Cleft Lip and Cleft Palate

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Surgical Repair of Cleft Lip and Cleft Palate




Guest:  Dr. Christopher Discolo – Otolaryngology - Head & Neck Surgery

Host:  Dr. Linda Austin – Psychiatry


Dr. 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?


Dr. 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.


Dr. Linda 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 feeding. 


Dr. Linda 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 correct? 


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.


Dr. Linda Austin:  And so, then, Dad gets to be involved in that process, in the feeding of the baby.


Dr. Christopher Discolo:  Yes.


Dr. Linda Austin:  Okay.  So, feeding is one.  At what age might an infant have their first surgery for cleft lip or cleft palate?


Dr. 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.


Dr. Linda Austin:  And why is that?  Why is it done in two stages?


Dr. 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.


Dr. 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?


Dr. Christopher 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. 


The 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.


Dr. Linda Austin:  How do you help a child with that painful situation?


Dr. Christopher Discolo:  We provide pain medication after surgery so the children are kept comfortable.


Dr. 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?


Dr. 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. 


Dr. Linda Austin:  So, there are those two surgical procedures.  How about afterwards, as a child matures, are there further procedures after that?


Dr. 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.


Children 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.


Dr. Linda Austin:  And how long does that surgery take?


Dr. Christopher Discolo:  That surgery takes about one to two hours as well.


Dr. Linda Austin:  Well, that’s not so long.  I mean, that’s not like, you know, a five or six hour operation, for example.


Dr. Christopher Discolo:  No, the surgery itself is pretty short, but that’s a pretty decent recovery for the kids also.


Dr. 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 palate?


Dr. Christopher Discolo:  The overall incidence is about 1 in every 1,000 births. 


Dr. 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?


Dr. 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. 


Dr. 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.


Dr. Christopher Discolo:  That’s correct.  And the overall chance of the child to have a very normal life is very high.


Dr. Linda Austin:  Good news.


Dr. Christopher Discolo:  Very good news.


Dr. Linda Austin:  Dr. Discolo, thanks so much for talking with us today.


Dr. 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.




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