Learning to Close the Cleft

New ways of detecting and treating a widespread birth defect

Cleft palate and cleft lip, which often occur together, are among the most common birth defects in the world. In the U.S. they afflict about one out of 750 babies. The lip is easily sutured by a plastic surgeon within ten weeks or so of birth, but the gap in the roof of the mouth, usually open clear through to the nose, cannot be closed until the facial bones have grown. This may take a year or more. That period can be trying for both parents and child. First there is the shock of the baby's disfigurement. In addition, affected infants cannot suck normally; they must be fed in an upright position, often with an eyedropper or milk-soaked sponge. They also tend to remain hospitalized longer than normal newborns and grow less quickly. Later they may have speech problems.

Two recent medical advances, however, should lessen these problems. The first is the use of ultrasound scanning. High-frequency-sound-wave tests, given to many expectant mothers to check fetal development, can detect a cleft palate if administered in the last few weeks before birth. Devised by doctors at the Women's Hospital in Houston, the method may provide unpleasant information, but, says Dr. H. William Porterfield, president of the American Society of Plastic and Reconstructive Surgeons, "at least parents have the opportunity to plan for what can and should be done in an atmosphere of reasonable calm."

A new treatment developed by a New York dentist may prove to be the best option. At Elmhurst City Hospital, in Queens, N.Y., Dr. Jerome Markowitz has been custom fitting cleft-palate babies with what he describes as an "overextended denture without teeth." The plate allows infants to be given an ordinary bottle or even to be breast-fed in a normal position. Markowitz tries to get the device into place within 24 hours after birth so that the baby will not consider the object foreign. It takes him about an hour to make an impression of the baby's mouth and craft the appliance in quick-setting acrylic. As the child grows during the first year, Markowitz adjusts the prosthesis and replaces it with a larger one four to six times.

Besides making feeding easier, the device shortens the newborn's hospital stay. Moreover, once the child is home, its preverbal crying and gurgling noises sound reassuringly normal to parents. Finally, and most important, the plate actually appears to foster to some degree the closing of the palate. Markowitz, who has been using such plates for seven years, says, "I've seen drastically defective palates fill in by 70% to 80% in ten months." Perhaps as a result, children fitted with the gadget seem to develop clearer speech than most cleft-palate youngsters. Says Plastic Surgeon Saul Hoffman, director of the Cleft Palate Center at New York City's Mount Sinai Hospital: "We're all in favor of it. The prosthesis seems to narrow the opening and make surgery easier. We think it has something to do with keeping the tongue out of the opening, which allows bone to form."

As for the plate wearers themselves, they adjust painlessly. In fact, when a plate is lost or broken, the child usually refuses to feed until a new one can be inserted. -

This file is automatically generated by a robot program, so viewer discretion is required.