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 Cleft Lip and Palate 
 Presurgical Orthopedics for Babies with Cleft Lip and Palate Purpose Your plastic surgeon has requested that your baby wear a small plastic plate and lip tape. This is also known as “Presurgical Orthopedics” and is designed to prepare your baby for the best surgical result. Presurgical orthopedics narrows the gap in the lip and gum, improves the symmetry of the nose and minimizes the size of the lip scar from surgery. In addition, the plate keeps the tongue out of the gap in the roof of the mouth (palate), and allows the gap in the palate to narrow naturally minimizing future palate surgery. For babies with “bilateral cleft,” that is, a gap on both sides, presurgical orthopedics also brings back the small central portion of the lip and gum in a controlled fashion. This greatly simplifies the surgical repair of the lip and gums, as well as reduces the occurrence of postsurgical “fistulae” or small holes after surgery. In addition to improving the surgical result, the plate also makes it easier to feed your baby. With the plate, your baby will find it easier to suck because the plate provides a smooth comfortable surface to suck against. You will also find that with the plate in place, much less fluid escapes through the nose during feeding. This too will make feeding easier for your baby. As you are aware, the clefting process leads to obvious problems with the soft tissues of your baby’s face and palate. Less obvious is the effect on the bones that house your baby’s teeth, form the palate, as well as the effect on the cartilages that shape and support your baby’s nose. During the first 3 months of your baby’s life, the levels of estrogen (a hormone) is relatively high in your baby’s blood stream. High levels of estrogen allow cartilage in the nose, which is usually resistant to being reshaped, to be quite mouldable. Once your baby is past this stage, the cartilage is set in an asymmetric shape that is difficult to correct surgically. However, if the cartilage forming the nose is reshapen within the mouldable period, a more esthetic shape may be established. |