The cleft lip and palate service is run through Christchurch Hospital. All consultations are performed at the public hospital. Cleft lip and palate patients are seen by Mr Kenton-Smith.
The members of the team are:
When does Mr Kenton-Smith see his patients?
Mr Kenton-Smith sees his patients at the time of diagnosis. He will then contact other members of the team as required. Cleft lips, and some cleft palates, are usually diagnosed through ultrasound prior to the baby's birth. Mr Kenton-Smith is happy to meet with parents-to-be to discuss the process and management of their cleft lip or cleft palate baby. Cleft lip and palate patients are followed up regularly until the age of 18-20 years old. Mr Kenton-Smith takes referrals from the whole of the South Island. If your baby is born in Christchurch, he or she is usually seen by Mr Kenton-Smith within two days of being born. The baby will also be seen by a speech therapist who will discuss feeding issues with you. Mr Kenton-Smith will decide whether a plate will be required to be inserted into the palate. This is usually made by the orthodontist, Peter Fowler. Mr Kenton-Smith will talk through the severity of your baby's cleft and the likely procedures which will be required to correct this.
Can I breastfeed my baby?
Cleft lip babies usually breastfeed very well. As the severity of the cleft palate increases the chances of being able to solely breastfeed reduce. A wide unilateral (one-sided) cleft lip or bilateral (two-sided) cleft lip baby is unlikely to be solely breastfed. These babies may be fed by bottles with special attachments, eg a pigeon teat. Breast milk can be expressed to use in the bottles. Midwives, lactation consultants and speech and language therapists will be there to help ensure your baby is feeding well prior to discharge from the hospital.
Cleft lip and palate surgery is staged. Here is an overview of the commonly performed procedures:
Unilateral (one-sided) cleft lip repair
Unilateral cleft lip repairs are generally performed by Mr Kenton-Smith when the baby is 4 months old. Surgery generally takes just under 2 hours and your child stays in hospital for 2-3 days. During the procedure, the lip is repaired and the nose reshaped. Nasal splints are inserted, these help reshape the nose. These are left in place for approximately 2 months. Seven days after their first surgery your child is returned to theatre, briefly, to remove the stitches. You are advised to tape the scar for a few weeks afterwards. Then vitamin E cream should be used 2-3 times a day whilst the scar settles and then continued once a day for the following few months.
Bilateral (two-sided) cleft lip repair
Bilateral cleft lips are also repaired at around 4 months, with stitches being removed in theatre 7 days later. Again, a soft silicon splint is inserted into the nose and left in place for a few months. This helps maintain the nasal shape.
Cleft palate repair
Cleft palate repair is generally performed at around 9 months of age. In some children, who grow slowly or have small jaws, Mr Kenton-Smith may decide to wait until 12 months of age before repairing the palate. During surgery, which lasts about 2 hours, the gap in the hard palate is repaired. The most important part of the procedure is the repair of the speech muscles within the soft palate. Mr Kenton-Smith generally performs this under the microscope. Following this, the soft palate is repaired and your child will be returned to the Recovery Room where a close eye is kept on him or her. You can join your child in the Recovery Room once he or she has woken up. There is generally a small amount of bleeding which, when mixed with saliva, can look more significant than it is. Following cleft palate repair children generally spend 1 or 2 nights on the High Dependency Unit and are in hospital for 2-3 nights.
Will my child need grommets?
Children with cleft palates have a much higher incidence of glue ear and Mr Kenton-Smith will arrange for you to see an Ear, Nose and Throat Surgeon prior to cleft palate repair. Grommets can be inserted at the time of cleft palate repair if your Ear, Nose and Throat Surgeon feels that this is required.
Following cleft lip and cleft palate repair your child is followed up regularly to watch the general development and speech development. During follow-up, speech is monitored and speech therapy may be required. Sometimes further investigation of speech with a videopalatogram and nasendoscopy is required before school age. Approximately 1 in 10 children with a cleft palate repair will require a further tightening procedure at the back of the throat.
Orthodontics and bone grafting
When your child's adult teeth have grown, plans will be made for orthodontic treatment to repair the gum line for bone grafting. The gap in the alveolus, or gum line, will be packed with bone taken from the hip during an operation which lasts approximately 1.5 hours. Following this procedure the canine teeth will drop down into the gap and further orthodontics will be required to give your child a nice smile. Excellent oral hygiene is required from birth to 18 years to benefit fully from the orthodontic treatment.
When your child has finished growing, at the age of 17-18, they may be keen on having their nose reshaped. This is called a rhinoplasty. This can greatly increase your child's self-confidence if the nose is misshapen prior to surgery. Other procedures that are sometimes required include upper jaw surgery, ie Le Fort osteotomy. This is discussed during Cleft Lip and Palate Clinic if the upper jaw lags behind in growth in comparison to the lower jaw. This surgery is generally performed at 18 years old, prior to rhinoplasty.