Cleft Lip and Palate Presurgical Orthopedics

Cleft palate before and afterCleft palate before and afterCleft palate before and afterThe first thing we would like to say about Cleft Palate treatment is: You've come to the right place! We love all our patients, but we have a special place inour hearts for our Cleft Palate babies and their families. Dr. Pocock and his team will help you and support you through this new experience. Soon, you will be able to share your success story with other new parents with cleft babies. It's a wonderful, caring community.

Through our commitment to continual education and harnessing every possible advantage for positive outcomes, we apply a technique known as Pre-surgical Orthopedics for Neonatal Cleft Lip and Palate. It’s a technical sounding title for a procedure that prepares your baby’s mouth and facial structures for the absolute best surgical results. Naturally high levels of estrogen in your baby’s bloodstream (until three months old), allow for the movement and molding of cartilage and facial structures to simplify surgical procedures and enhance the overall outcomes. Once your baby is past this stage the cartilage becomes "set" in shape. Therefore, if these cartilages are allowed to set in a deformed shape it will be more difficult to reshape them surgically when older.

Within this early 3-month window, it is also possible to re-position the tooth-bearing parts of the jaws. This helps with the shape of the face in the upper lip area and reduces the tissue strain when the surgeon closes the lip. The appliances used for these procedures also help with feeding. Your baby will not yet be able to create a fully sealed suction, but they will be able to squeeze a nipple between the gum pads and the appliance allowing your Baby to feed without you squeezing the bottle. This all helps to put on weight, which is vitally important and allows surgery to proceed on time.

Our list of Frequently Asked Questions has been built over the almost three decades that Dr. Pocock has been delivering these services. Please read through and feel free to ask for clarification on anything you wish, as our goal is to educate parents on the full spectrum of this important service.

Cleft Palate FAQs

How is my baby going to look when the Cleft Palate surgeries are complete?

Fantastic! With the benefit of our wonderful team of specialists working with you and your baby through BC Children's Hospital, you can expect a great result. See our Graduates section for some amazing photos of our cleft palate patients.

What do Cleft Palate appliances look like?

Below is a picture of a cleft palate appliance. It is called a Nasal Stint and the design can vary depending on whether the cleft is single (Unilateral) or double (Bilateral). This is a Bilateral Nasal Stint:

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Below is a picture of a baby with a bilateral cleft lip and palate with all of the tapping in place, it looks really complicated but don't worry we will lead you through the process step by step.

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The following diagrams show the general way appliances work in a bilateral case followed by a unilateral case.

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How is the Cleft Palate treatment going to be carried out, by whom, and where?

The measuring of your baby and the manufacture and fitting of the appliance will be performed by Dr. Pocock. An impression or mould will need to be taken, this is usually done when the baby is 7-14 days old and this procedure is most frequently performed by your Orthodontist in the Operating Room (OR) with an Anaesthetist "standing by". Your baby will not be anaesthetised, the Anaesthetist is just there to monitor your baby and help with breathing if there is a concern. This however is very unlikely, we just want to be as careful as possible. Our nurse practitioner or the Anaesthetist will advise you as to when your baby's last feed before the procedure is to occur.

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Once the baby is returned to you after about 15 - 30 minutes you may feed him. At this stage you will be given an appointment at your orthodontist's office for the fitting of the appliance usually within a couple of days. The rest of the adjustment appointments will occur at the orthodontist's office. A plaster cast is made from the impression and then a technician will fabricate the appliance.

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At the Orthodontist's office the appliance will be fitted and you will be given instructions on how to place and remove it; including how to use the various tapes and elastics.

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Below shows the steristrips and orthodontic elastics

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The lip tape must be placed very tightly—ideally the lip will blanch (look white)

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Sometimes denture adhesive is used help the appliance stay secure

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What do the parents have to do for our Cleft Palate baby?

  • Clean the appliance and palate at least once per day
  • Change the lip tape several times a day making sure to keep pressure on the lip and underlying tissue
  • Change the base tape and steristrips as needed. The base tape can be left on for up to a week before changing it. This protects the cheeks from the more frequent changing of the lip tape and steristrips

Photos will be taken and a copy will be given to you for your records. Sometimes the completed appliance will be delivered at this time, while in other cases the rest of the appliance will be fitted a week following. Adjustment appointments will then usually occur at weekly intervals, sometimes longer especially for out of town patients.

Babies with bilateral clefts will have some additional modifications to the appliance and taping made at about 6 weeks.

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Just prior to surgery the wire component will be removed but the acrylic plate will stay in until the palate surgery at between 10 -14 months.

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What is the timeline for Cleft Palate treatment?

  • Impression at the OR 7-14 days of age
  • Fit appliance several days later
  • Adjust appliance weekly
  • Remove wire component just prior to surgery
  • Lip repair surgery at approximately 3 months of age
  • Acrylic plate to stay in after lip surgery
  • Palate surgery at 10-14 months no need for acrylic plates any longer

Will the Cleft Palate appliance or taping hurt my baby?

Babies get used to these appliances quite quickly, it will surprise you how adaptable they are, also you will see improvements in appearance almost immediately. Although you will feel "all thumbs" to begin with it will soon become routine and very rewarding as you see the fruits of your labours in the permanent improvement you have helped make in your babies appearance!

What problems might we have while waiting for the first Cleft Palate surgery?

  • Loosening of the plate. Try tightening the elastics by moving the steristrips higher on the plastic skin, or add some denture adhesive to the plate.
  • Skin rashes. Try to move the tape or plastic skin to different areas, or if the problems persist, phone the Cleft Clinic at 604-875-3146 and ask to leave a message for Sandra Robertson. She has some great ideas and remedies.
  • Sore, red or bleeding areas on the palate or nose. Call the orthodontist to arrange an adjustment.
  • Baby pulling plate out! This may happen especially later in treatment, it is important to keep the plate in if at all possible. Use more denture adhesive, put mitts or socks on the hands. If the plate is left out the tongue can push up into the cleft possibly widening the cleft in the palate and therefore making the palate surgery more difficult and prone to complications.
  • Plate not fitting because of teeth coming in. Call the orthodontists office to have the plate adjusted.

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