CLP Specialities

 

The Cleft Lip and Palate Team in Cork University Hospital is a well-established team of professionals. The team includes a group of cleft specialists who work together with patients and families to design a treatment plan for the individual child’s cleft care.

Plastic Surgery

The type of surgery and the number of operations very much depends on the type and severity of the cleft. A very mild cleft of the lip may only require a single, small operation – whereas a wide, bilateral cleft of the lip and the palate will often require multiple operations.

Lip repair - Clefts of the lip are generally repaired between 3 and 4 months

Palate repair- Cleft of the palate is generally repaired at about 9-12 months of age.

Secondary surgery (in a small group of patients) - Sometimes, children aged 3 or 4 years old require a further operation to their palate if it is still not working properly despite the initial repair – this may be in the form of a palate re-repair and lengthening or an operation called a pharyngoplasty.

Alveolar bone grafting - Children with a gap in the gum line may require a bone graft – known as alveolar bone graft – to allow the teeth to grow normally – this is often done between 9 and 11 years of age.

Maxillary Advancement -Adults who have had very severe clefts may have a problem with facial growth in that their upper jaw doesn’t grow as well as their lower jaw – their teeth don’t meet properly. Some teenagers may need an operation to bring the upper jaw forward and possibly their lower jaw back a little. This is called orthognathic surgery.

Cosmetic procedures - Occasionally, a minor revision of the lip or the nose is also done at this time. There may be aesthetic issues with the appearance of the nose. These problems are often addressed with a rhinoplasty at the end of their treatment.                    

In the more complicated of cleft cases, we try and keep the number of operations to a minimum. While the idea of several operations sounds daunting at first, it must be remembered that these procedures take place over a twenty year period – each individual procedure being relatively straight forward.

Speech and Language Therapy

The Specialist Speech and Language Therapist (SLT) is involved from the time of birth, to assess and manage feeding and speech difficulties. Babies born with a cleft palate may need extra help to feed. The SLT will be able to establish what type of cleft your baby has and identify the most suitable feeding method. This may include using specialised bottles and teats, or in some cases using a nasogastric (NG) feeding tube. Once a suitable bottle/teat has been identified, you will be provided with feeding guidelines and purchasing information. The SLT will continue to offer feeding support and guidance following discharge from hospital.

Following palate repair, speech therapy is often required as the child learns how to use his/her repaired palate. Standardised speech assessments are arranged by the Specialist SLT in CUH at 18 months of age, 3 years of age and 5 years of age. If required, your child will be referred to your local community SLT service for regular speech and language therapy. Your child will also be reviewed by the Specialist SLT at the multidisciplinary team clinic meetings, every 1-2 years, through to young adulthood.

The SLT also offers a specialist resonance/‘second opinion’ service for individuals with speech issues associated with the palate, i.e. nasal sounding speech. This is referred to as Velopharyngeal Dysfunction (VPD). VPD can affect individuals with or without a history of cleft palate. VPD can be associated with cleft palate, hearing impairment, neurological conditions, structural issues (adenoids/tonsils) or removal of a nasopharyngeal carcinoma.

During speech, the soft palate moves to close off the space between the mouth and the nose. If an individual has nasal sounding speech, this could be due to a hole in the palate (a fistula) or because the palate is unable to make contact with the back wall of the throat. As a result, a small number of children born with cleft palate require secondary surgery at a later age. The decision to go ahead with this surgery requires careful analysis of speech, specialised objective investigations (lateral videofluoroscopy/ nasendoscopy) and joint decision making with the Plastic Surgeon. Lateral videofluoroscopy and nasendoscopy may be arranged to decide whether secondary surgery is required. Lateral Videofluoroscopy is a 2 dimensional moving x-ray. It involves talking whilst taking a continuous X-ray. It allows visualisation of the soft palate, tongue and throat wall, from the side, during speech. Nasendoscopy is a 3 dimensional image. It involves passing a very small camera into the child’s nose to see how the palate moves from above.

ENT

The Ear Nose and Throat surgeon is involved in the management of cleft palate. The muscles that lift the palate are required to open the eustachian tube in the middle ear. As a result, children born with cleft palate are at increased risk of fluid build-up and fluctuating hearing levels. This can adversely impact speech and language development. The ENT surgeon may advise to place ventilation tubes (“grommets”) that allow air into the middle ear, reducing the fluid build-up. This surgery involves making a small hole in the ear drum, into which the tube is placed. Tubes are not permanent and usually fall out spontaneously within 6 months but can break the cycle of fluid build-up in the middle ear. This surgery may be done under general anaesthetic at the same time as primary palate repair.

Dentistry

The Paediatric Dentist sees children born with clefts within their first year, sometimes even before their teeth have erupted. The Dentist plays a vital role in helping to prevent tooth decay, gum disease and early loss of teeth, all of which may affect future orthodontic treatment. As well as reviewing the children periodically, the Paediatric Dentist will also refer them to a HSE designated dentist for regular, preventative based care including dietary advice and oral hygiene instruction, as well as any necessary dental treatment. Children with cleft lip and/or palate are considered to be a high priority group of patients as the cleft may cause several types of disruption to the development and growth of their teeth. They have a higher rate of tooth decay and, because of the different anatomy in the mouth, dental treatment can be more difficult to provide.

The Orthodontist attends the multidisciplinary clinic on a monthly basis. Orthodontic assessments & treatments are carried out in later adolescent years. The orthodontist acts as a link with paediatric dentistry and maxillofacial surgery, if required.

Orthodontics

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Maxillofacial Surgery

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Social Work/Counsellor

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Clinical Photography

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Liaison with other related departments and services:

  • Department of Anaesthesia
  • Departments of Neonatology & Paediatrics
  • Primary Care Services – PHN, SLT, Dentistry, Audiology, Orthodontics
  • Clinical Nutrition & Dietetics

 

Services Provided:

  • Antenatal counselling clinic - This service is available to parents, following an antenatal diagnosis of cleft lip +/- palate, who are referred by professionals in the area of foetal medicine
  • Routine Speech Assessments – 18 month, 3 year, 5 year
  • Dental clinics – routine dental hygiene checks, alveolar bone grafting, maxillary advancement, orthodontics
  • Multidisciplinary Team Clinic
  • SLT Resonance clinic
  • Joint SLT/ Plastic Surgeon clinic
  • Lateral Videofluoroscopy
  • Nasendoscopy