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Reconstructive surgery for facial clefts in children


Facial clefts occur in about one of every 600 births in the United States, making them one of the most common birth defects. Every year, approximately 6800 newborns in the United States are born with a facial cleft.

A cleft lip and/or cleft palate occur when certain structures in the mouth and face do not fuse together properly during the first few months of pregnancy. A cleft lip is an opening in the lip, which can extend into the gum line and the base of the nose. It can be on one side (unilateral) or both sides (bilateral). A cleft palate can occur with a cleft lip or also can occur on its own. The palate is the roof of the mouth and is made up of both the hard and soft palate. 

Most doctors and researchers agree that the causes of clefts are multifactorial and may include a genetic predisposition as well as environmental issues such as drug and alcohol use, smoking, maternal illness, infections, or lack of folic acid. Sometimes, a cleft is associated with a syndrome that involves abnormalities of other body parts.

Although most newborn patients with a cleft lip are not in a life-threatening situation, it is common that babies with a cleft palate may have more feeding difficulties and need special bottles and nipples (as well as careful positioning) to feed adequately. Likewise, an untreated cleft palate may create other difficulties later in life including chronic dental problems, ear infections or impaired hearing, speech problems, and possibly more challenging social dynamics and/or altered self-perception. The decision for early surgical intervention can provide improved medical and physical outcomes as well as decrease other negative psychosocial impacts. However, the first step for early intervention is identification and diagnosis.

Cleft lip and palate can be identified on prenatal ultrasounds as early as 11 weeks gestation. Montana Perinatal Center specializes in detailed fetal anatomy surveys and has special accreditation from the American Institute for Ultrasound in Medicine. When a cleft lip or palate is identified, perinatologists look very closely to see if it is an isolated finding or part of a more complex problem. Parents are obviously quite concerned about the medical and psychosocial implications for their unborn baby. Education is an essential process for a family with a child that has a cleft defect.

The cosmetic outcomes for cleft lips have improved significantly over the past 20 years and the surgical results can be quite amazing. It takes a team of specialized providers to achieve this goal as the area of concern involves a lot of interconnected structures and specialized body parts. Those teams must work together cohesively to ensure that proper treatment takes place in a timely manner. Team members necessary to execute a successful cleft surgery may include the following types of providers: perinatologist, genetic specialist, pediatrician, plastic and reconstructive surgeon, pediatric anesthesiologist, pediatric dentist, speech-language pathologist, audiologist, ENT doctor (ear, nose and throat), ophthalmologist, psychologist, and social worker or mental health provider.

Care for a young child with a facial cleft should start as early as possible following delivery. Immediately after birth, a lactation specialist and pediatrician will see the baby to ensure that feeding is sufficient. Within days or the first week of life, the baby will be evaluated by other members of the craniofacial team, such as speech therapists and plastic surgeons. This is to ensure that the baby is eating and growing appropriately and to outline a future plan. Surgical options will be discussed and a timeline will be established depending on the specific type of cleft that the infant has.

As a parent, the idea of traveling for medical treatment can be overwhelming and may be incredibly disruptive for families. Fortunately, the Flathead Valley area has a local resource where all these services and specialists can be found. The Montana Children’s Specialists at Kalispell Regional Healthcare are able to provide full-scope services for newborns with isolated cleft lip and palates to those with complex genetic syndromes for all Montanans.

The leader of our craniofacial team is Dr. Michelle Spring, a board-certified, fellowship-trained plastic surgeon. She was fortunate to spend one of her fellowships with a nonprofit organization called ReSurge (formerly Interplast). This experience included extensive training under the watch of many skilled craniofacial surgeons to help children in underserved countries that needed cleft lip and palate surgery. These life-altering surgeries were provided at no cost to families and the experience was quite moving for Dr. Spring. In fact, she still offers her surgical skills to children in need with a trip to Mozambique planned for the summer of 2018.

Back home in the Flathead Valley, Dr. Spring provides this same service to area children in collaboration with many other experienced Montana Children’s Specialists. She is the practicing medical director at Glacier View Plastic Surgery in Kalispell, Montana where she and her staff specialize in progressive cosmetic and aesthetic procedures. The providers at Glacier View Plastic Surgery also serve the community as reconstructive surgical specialists. For example, many breast cancer survivors undergo reconstructive plastic surgery as a final step to feel more whole post-cancer.

“It’s a great feeling to help a person of any age look at themselves in the mirror and love what they see. Sometimes that is for medical reasons and other times it’s to boost self-confidence,” Dr. Spring explains. “Helping children is one of the highlights of my work and the goal is to help provide them with an improved future.”

Dr. Spring is available to perform consultations for families regarding surgical management and expected outcomes for prenatal and postnatal diagnosed babies with cleft lip and palate. Education and background about facial clefts is greatly beneficial to families prior to birth. This information helps them with their prenatal choices while also being better prepared for what is to come following delivery.

As with any pregnancy, routine visits to your obstetrician are necessary to ensure healthy progress and growth. These routine visits can also help identify any anomalies early. Early detection usually means more choices and reduced risk through collaboration and planning. Montana Perinatal Center offers advanced diagnostics such as high-definition ultrasounds, fetal echocardiograms and genetic screenings to help pinpoint and prepare for any neonatal complications. Read more about these services online at krh.org/MontanaPerinatalCenter.

This article originally published in Montana Woman Magazine, August 2018.


By Debra Guinn, MD, maternal-fetal specialist, Montana Perinatal Center

Maternal-fetal medicine specialist Debra Guinn, MD, joined Kalispell Regional Healthcare in June 2015, opening the Montana Perinatal Center to care for mothers with high-risk pregnancies and perform diagnostic ultrasound, prenatal diagnosis and fetal therapy. She works together with obstetrical providers, neonatologists, pediatricians, nurses and anesthesiologists to develop an optimal plan of care to promote the health and well-being of both mothers and unborn children. Dr. Guinn serves as the medical director for Kalispell Regional Medical Center’s maternal and fetal medicine program.