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Texas Cleft-Craniofacial Program

Teichgraeber_LargeAs one of the more common birth defects, it is estimated that clefts of the lip, palate or both occur in approximately one in 700 births. Typically, the lip segments of a fetus join together during the seventh week of pregnancy and the palate closes by the 11th week. When this process does not occur, for either genetic or environmental reasons, the result is a cleft lip and/or palate.

According to John Teichgraeber, M.D., FACS, professor and director, division of Pediatric Plastic and Craniofacial Surgery, and leader of the Texas Cleft-Craniofacial Program, cleft lip and/or palate cases can vary widely in severity. Although they are highly treatable, many children will require multiple procedures throughout their childhood to ensure a normal level of oral function and appearance.

“The emotional effects surrounding a cleft diagnosis can be overwhelming, which is why early detection, education and access to appropriate resources are essential in ensuring the best outcomes for both the baby and family,” said Dr. Teichgraeber. “It’s important for families to find a program with the breadth and depth to provide not only surgical expertise, but psychological support as well.”

The Texas Cleft-Craniofacial Program is one of the largest programs of its kind in the region. The multidisciplinary team includes a number of specialists, including affiliated plastic and oral surgeons, pediatric dentists, dietitians, orthodontists, geneticists, speech therapists, otolaryngologists and audiologists, among others. Together they have successfully treated patients across the spectrum of clefts, from those with small notches in the lip to those with more advanced cases involving large openings bilaterally of both the lip and the hard and soft palates. “There are multiple variations, but we see mostly cleft lip and palate,” said Dr. Teichgraeber, adding that last year alone they treated 40 new cases of cleft lip and 50 new cleft palates.

Diagnosis and Treatment

Cleft lip and palate are often diagnosed in utero by maternal-fetal medicine specialists, who also perform additional tests to evaluate for other associated anomalies. In most cases, management of pregnancy is routine and the Center works closely with the obstetrician to determine the patient’s delivery plan. There are no fetal treatments for clefts, therefore coordination of care for the baby after birth is recommended. Babies undergo surgery during the first year of life, typically in two stages. The lip is repaired between 3 and 6 months of age and the palate between 10 months and 1 year. In later childhood, many will undergo upper jaw surgery with bone grafting and revision of both the lip and nose, usually somewhere between the ages of 7 and 10 years old.

Dr. Teichgraeber credits early detection in utero as one of the most critical advances in terms of helping parents cope with a cleft lip and/or palate diagnosis, and he says the team sees approximately 60 percent of cases prenatally. “A baby’s smile is communication, and the emotional impact of this diagnosis is upsetting. For parents to have the ability to learn about what this diagnosis means early on gives them a head start. They are better educated and more prepared to see past the small deformity.”

Below are progression photos of a Texas Cleft-Craniofacial Program patient ranging from 1 month to 8 years old.

Texas Cleft Patient Progression

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Download our cleft-craniofacial fact sheet »