Clefting of the lip and palate is a congenital deformity; this means that patients are born with a facial cleft. The reasons for the development of a facial cleft are numerous and complex, and not completely understood. Phenotypic expression of facial clefts is also variable- this means that there are numerous ways that the clefts manifest. They can be unilateral, bilateral, complete, or incomplete. This is why some people have a cleft lip, some have a cleft palate, and some have both.

The interesting thing about clefts is that they pass through multiple structures. They can pass through the lips, the nose, the upper jaw bone that holds the teeth, and the palate. Therefore, so many functions are affected by a cleft - breathing, speaking, suckling, swallowing, and even hearing.  Therefore, there are entire health care teams devoted to the treatment of a cleft, with multiple disciplines: pediatric medicine, otolaryngology, plastic surgery, oral surgery, pediatric dentistry, orthodontics, social work, speech therapy, and genetics. These disciplines make up a cleft team.

The reason having a cleft team is so important is that the specialists on the cleft team are able to communicate and collaborate regarding the care of the patient with a cleft. This direct communication is critical for timing of certain interventions to treat the cleft at different stages of life and development.

The basic stages of cleft treatment are as follows:

Birth to 2 years

Nasoalveolar molding

Surgical repair of the lip and nose

Surgical repair of the palate

2 -6 years

Revision surgery if necessary

Comprehensive dentistry

Speech therapy

7-12 years

Orthodontic palatal expansion

Alveolar bone grafting/closure of oronasal fistula

13-17 years

Orthodontics

Possible distraction

Possible orthognathic surgery

18+

Revision rhinoplasty if necessary

Dr. Rosenfeld is an active member of the Northwell Cleft Team, known as the Hagedorn Cleft Palate and Craniofacial Center. As an oral and maxillofacial surgeon on the team, Dr. Rosenfeld’s primary role is the alveolar bone grafting and closure of oronasal fistula, which generally happens between the ages of 7 and 12, and then facial distraction or orthognathic surgery, which happen at later stages of development. Dr. Rosenfeld works closely with the other members of the team to ensure proper timing of the procedures, as clear communication between healthcare providers is so important to successful outcomes.