Cleft Lip And Palate Therapy

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Cleft Lip And Palate Therapy
Cleft Lip And Palate Therapy

Video: Cleft Lip And Palate Therapy

Video: Cleft Lip And Palate Therapy
Video: Cleft Lip and Palate Treatment at Johns Hopkins 2023, March

Cleft lip and palate

After malformations of the extremities, cleft lip and palate (LKG) are the most common congenital malformations with around 15 percent. In Central Europe, one in 600 to 700 newborns is affected, boys slightly more often than girls. The diagnosis is usually made during pregnancy. Treatment extends from birth to adulthood. The aim is a functional and aesthetic rehabilitation of the patient. This is only possible through good interdisciplinary cooperation between all the disciplines involved in the treatment, ie optimal therapy is only possible in a well-coordinated treatment team.


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  • What are the causes of cleft lip and palate?
  • What gap shapes are there?
  • How is the diagnosis made?
  • "> How is the cleft lip and palate treated?


  • Whom can I ask?
  • How are the costs going to be covered?


What are the causes of cleft lip and palate?

Various factors can lead to the formation of LKG gaps, including:

  • External influences during pregnancy, such as maternal diseases (especially viral diseases, e.g. rubella, mumps, toxoplasmosis), vitamin deficiency, teratogenic substances (side effects of drugs, alcohol and drug abuse), physical harmful effects (X-rays and ionizing radiation).
  • Genetic disposition: According to recent research results, genetic factors in terms of heredity play a much greater role than previously assumed.

In many cases, however, the trigger for the malformation cannot be identified and thus the cause cannot be explained. For prophylaxis (in addition to avoiding the external influences listed above), the intake of polyvitamin preparations (B-complex) and folic acid can be useful. Since the formation of a gap occurs as early as the fifth to eighth week of pregnancy, prophylaxis or avoidance of harmful influences is crucial, especially in the first weeks of pregnancy.

What gap shapes are there?

A distinction is made between different gap shapes, depending on the characteristics:

Cleft lip:

  • Minimal shape: lip notch
  • Cleft lip on one side (incomplete, complete)
  • Cleft lip double-sided (incomplete, complete)
  • Cleft lip and jaw (one-sided, double-sided; incomplete, complete)
  • Cleft lip and palate (one-sided, double-sided; incomplete, complete)

Isolated cleft palate:

  • (Complete) cleft palate (= hard and soft palate)
  • Isolated cleft soft palate
  • Special forms: Uvula bifida, submucosal cleft palate

Gap-related malfunctions

Depending on the extent and localization of a gap, a wide variety of impairments can occur, especially:

  • Relocation of the tongue and respiratory hindrance (lack of palatal vault as tongue abutment);
  • Problems with feeding (lack of negative pressure when sucking);
  • Ventilation disorders of the middle ear (→ recurrent otitis media);
  • Disturbances in sound formation due to the lack of separation of the nose and throat area;
  • Mouth breathing (due to obstructed nasal breathing);
  • Tooth number and position abnormalities;
  • Growth impediment in the upper jaw;
  • Susceptibility to caries (insufficient mineralization of the tooth enamel);

How is the diagnosis made?

In most cases, from the 20th week of pregnancy onwards, ultrasound can detect the formation of a cleft if the lip is involved, but isolated cleft palates are usually very difficult to diagnose. As part of an intrauterine magnetic resonance tomography, organ screening can be carried out to clarify accompanying malformations.

How is the cleft lip and palate treated?

The aim of the often protracted therapy is to eliminate or reduce as far as possible impairments caused by the gap, for example when eating or speaking, as well as aesthetic problems. The treatment requires multidisciplinary cooperation and should be coordinated or carried out by a competence center for oral and maxillofacial surgery. You can find more information and a list of specialized treatment centers on the website of the Austrian Society for Cleft Lip and Palate and Craniofacial Anomalies (

The surgical treatment concepts can differ from one another at the different treatment centers. Mostly they depend on the individual form of the gap formation and the respective surgical experience. However, the main steps are very similar at many centers.

In the first days of life, depending on the shape and severity of the crevice, the inclusion of a so-called palate plate ("drinking plate") can be advantageous. By separating the oral and nasal cavities, food intake should be facilitated. In addition, the position of the tongue is positively influenced and growth in the cleft jaw is guided (approach of the cleft segments). In the further course, so-called primary operations and, if necessary, secondary operations or corrective interventions are carried out. Some of these corrective interventions are already useful in preschool age, others only after the growth is complete.

Primary operation

This is understood to mean surgical measures that serve to primarily close the split and malformed structures:

  • At the age of three to six months, the first surgical step is to close the upper lip.
  • The palate is usually closed between the sixth and twelfth month of life, in the majority of cases in a "one-step" closure (ie soft and hard palates are closed in one operation). In the case of "two-stage" closure, the soft palate is closed in the first procedure, while the hard palate is closed at a later point in time (at the latest in the third year of life).
  • At the age of about eight to eleven years, bone is deposited in the cleft jaw area (osteoplasty).

Secondary operation

This means "second operations" in the cleft area, ie surgical measures to improve function and aesthetics:

  • Aesthetic corrections to the lip and nose (these are possible at any time, depending on requirements, major corrective operations on the nose usually only after growth has finished);
  • Nasal bridge extension (for bilateral LKG gaps);
  • Closure of "residual holes" on the palate (oro-nasal fistulas);
  • Jaw correction to achieve a normal position of the jaws (especially the upper jaw).
  • Speech-assisting interventions are necessary if there are pronounced problems speaking (“open nasalism”, “hypernasality”) despite a complete occlusion of the palate and intensive speech therapy treatment.

Further measures of treatment

The operations are only part of the treatment of LKG columns. The following measures are just as important in therapy:

  • Breastfeeding advice: Support for nutrition is very important, especially in the first days of life. There are specially trained "lactation consultants" (IBCLC) - In certain cases, partial breastfeeding can be made possible.
  • Speech therapy: The assistance ranges from additional support in breastfeeding advice (advice on food intake, e.g. which teat to use or how to optimize posture or holding the bottle) to strategies to support language, speech and voice development of the child.
  • ENT medical care: Children with cleft palate suffer more from hearing disorders, but also swallowing disorders and speech disorders as well as delays in speech development. The ENT doctor can carry out appropriate examinations and, if necessary, take therapeutic measures or coordinate them with other disciplines such as oral surgery or speech therapy.
  • Dentistry, oral medicine and orthodontics / orthodontics: Orthodontic corrective splints and braces can improve misalignments.
  • Psychology: Psychological support can be helpful for parents as well as for adolescent patients and make it easier to deal with the disease.

Whom can I ask?

Malformations of the lip, jaw and palate are usually detected by the specialist in gynecology and obstetrics as part of the mother-child pass examinations, in particular using prenatal ultrasound. This is usually followed by a referral to a treatment center for cleft lip and palate, where the next steps are discussed during pregnancy. An exact diagnosis can be made immediately after birth at the latest.

How are the costs going to be covered?

All necessary and appropriate diagnostic and therapeutic measures are taken over by the health insurance carriers. Your doctor or the outpatient clinic will generally settle accounts directly with your health insurance provider. With certain health insurance providers, however, you may have to pay a deductible (BVAEB, SVS, SVS, BVAEB). However, you can also use a doctor of your choice (ie doctor without a health insurance contract) or a private outpatient clinic.

For more information, see Costs and Deductibles and What does a hospital stay cost?

Note Due to the considerable additional burden caused by cleft lip and palate, parents are in most cases entitled to an increased family allowance by law. Whether and how long this is granted depends on the severity of the gap shape and on a medical report.

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