Transcription:
Treating Cleft Lip and Palate at UK HealthCare

Scott Webb: Welcome to UK HealthCast from the University of Kentucky Healthcare. I'm Scott Webb. And today, we are discussing cleft lips and palates, including treatment options and how children with these conditions can live normal lives. And joining me today is Dr. James Liau. He's the Clinical Director for Plastic Surgery at Kentucky Children's Hospital. And I'm also joined by Brooke Wilson. She's a physician assistant in the Division of Plastic and Reconstructive Surgery at KCH. So first off, I want to thank you both for being on today. Dr. Liau, I'm gonna start with you. What is a cleft lip and palate?

Dr. James Liau: So a cleft lip and palate, it is something that's present at birth. It's congenital in nature. Probably the best way to explain it, it is basically an opening or split of the lip, the skin and then it goes a little bit above into like the nasal opening. The muscle underneath is also split as well and it can actually go backwards or posteriorly is what we say down into the mouth and the palate. And it can actually involve also the hard and soft palate. And it can be on one side or it can be on both sides.

Scott Webb: Yeah. And how do we know if our child has one? Is that something that's diagnosed in utero?

Dr. James Liau: Definitely, it is. Especially now with prenatal ultrasounds, you can usually see whether your child is going to have a cleft lip easily by the 20th week of gestation. So a lot of times, it's a good point because a lot of times we actually do our counseling with the parents and the families during this time, even before the child's born. Now, that's for our cleft lip. A cleft palate can be a little bit more difficult and it just has to do with sort of the angle how the ultrasound is done. Sometimes you can't see it, sometimes you can. So it's not uncommon for parents to not realize their child has a cleft palate until after their child is born.

Scott Webb: Yeah, I see what you mean. Is one or both of these, are they hereditary? Is there anything we can do to prevent cleft lip or palate in our children?

Dr. James Liau: There's really not much you can do to prevent it. And the idea of it being hereditary, yes, it can be passed down in families. But the majority of cleft lips and palates that we see tend to be spontaneous, which means that they just sort of occur. Now, it's not uncommon to talk to families. And they say, "Oh," and they start talking to other people in the family. And they're like, "Oh, my great aunt had one," or, you know, "Grandpa had one. We never knew him" type of thing. But in general, it is mostly spontaneous.

There are certain risk factors, obviously, but this is true for all sorts of birth defects. You know, a mother's health while she's carrying a child is really important. And things that moms have exposure to that they can avoid obviously will decrease the chance of a child having a birth defect, including cleft lip and cleft palate.

Scott Webb: So when we think of this as a birth defect and, as you say, there's really nothing we can do to prevent this, is this just a sort of a cosmetic thing or are there some real impacts on children's health?

Dr. James Liau: Yeah, I think the physical aspect of it or seeing it is probably the most dramatic because there's obviously a cleft there. However, you're right, it really does affect the overall child's health. They have difficulty feeding when they're first born, which can also be a real problem. As they go through life, issues with teeth become more apparent, issues with the nose in terms of breathing become more apparent as they become more active. As they get to the age of speaking, you can actually be able to eat with the cleft palate. It can take some work, even though you have palate with a cleft in it. However, what you can't do is talk. And as humans are very social beings and talking is the way that we really associate with each other, this is a very big problem. So not being able to talk is a problem with cleft palates and that obviously needs to be fixed as well.

Scott Webb: Yeah. So let's talk about, as you say, fixing. Let's talk about the treatment options, because I'm sure that's what listeners and parents would want to know. What are the treatment options?

Dr. James Liau: Cleft lip and cleft palates have been around for a while. And as we continue our work on there, things get really standardized in a way. But there are, you know, multiple treatments, not just surgical, but also treatments in terms of postoperative care, in terms of therapy and whatnot.

But in terms of surgical treatment, obviously, we repair the lip, we repair the muscle underneath there. We do a little bit of work on the nose to make things a little bit more symmetrical. And then after that, we then fix the palate where we'd line up the muscles in the proper way, make sure the cleft is covered. And these two surgeries, if a child has a cleft lip and cleft palate, these two surgeries we try to get done within their first year of life. It's kind of a big year for the families, big year for the child, you know, two major surgeries during that first year of life.

But after that, there are other things that we need to address. We had mentioned for the dentition, like your teeth, so we have to get that sort of fixed up. Sometimes there's bone in the gum line that needs to be replaced. So we address that when the kids are around teeth-bearing age, usually 7, 9, 10, 11 years of age.

The other aspect that we had kind of talked about before is speech and I really focus on that. And even though we fix the palate, sometimes the palate still doesn't function the way it should and speech becomes a problem. And obviously, I see kids get towards kindergarten age where they really become socialized with other kids. We want to make sure speech is tip-top, and sometimes that will also require surgery.

But as I mentioned, the therapies too, you know, during this time, even before we do any surgeries, speech therapy is ideal and it really helps out with teaching parents how to feed their child with their cleft. As they get along and start learning words and start learning to, you know, talk to other kids, speech therapy is extremely vital because it allows them to really sort of make sure that their speech is tip-top, especially with the repaired palate.

There's a lot of different options and it can get kind of complex. But that's, you know, why we have a team to help the parents get through all the decision-making and cleft care that can follow.

Scott Webb: Yeah, for sure. And I know you've got a great team. We're going to talk about that in a bit with Brooke. I just want to ask, you know, as a parent myself, I have a couple of kids. My daughter started eighth grade today, so it's kind of a fun day. When we think about our kiddos, our children, we want them to live as normal a lives as possible. So children with cleft lips and palates, will they be able to live normal lives, doctor?

Dr. James Liau: Oh, absolutely. I mean, that is our mission. Our goal for the team is that, yes, your child should be able to live a normal, healthy, happy life. And we really sort of stressed the fact that there's nothing that should hold your child back in terms of the cleft. Now, we have to do some work, obviously, and that's what the team is here for. But there is nothing that your child should not be able to obtain if they could not obtain it before.

Scott Webb: Brooke, I want to bring you in. How is Kentucky Children's Hospital different? And then why should folks choose KCH for their child's care?

Brooke Wilson: As Dr. Liau had mentioned, the treatment kind of involves multiple different teams or specialties within the healthcare system. And so here at the University of Kentucky and Kentucky Children's Hospital, we have created a multidisciplinary approach. And so we have a clinic set up where all of these specialties meet, and then the patient and their families can come in to this clinic and be seen by every specialty all in one day. I think this really gives us a unique approach in order to provide kind of early education for the families, early outreach, you know, for feeding therapy, sets up really good referral patterns to make sure that these patients are getting to the appropriate providers, and really just effective communication amongst the different disciplines.

And then at the end, we kind of all sit down and develop a team summary where we put together a document. We actually mail this out to the patient's families so that they kind of stay in tune with their overall treatment plan and know the next one that's moving forward.

I work really hard, as the cleft team coordinator, to try to make sure that all the teams are on the same page. Referrals are actually made and kind of followed up through, and that the families are updated accordingly, and that everybody just kind of stays on the same page.

Cleft treatment can be overwhelming, especially if you're a first time parent. And so I think the multidisciplinary approach provides a more organized way to keep things streamlined and keep stress at bay as much as possible. And we've also recently partnered with Office for Children with Special Health Care Needs, which really ensures access to all children across the state of Kentucky to this multidisciplinary care here at UK and within KCH.

Scott Webb: Brooke, before I give Dr. Liau a last word here. When it comes to these conditions, what are your takeaways?

Brooke Wilson: I will say, I do feel like here at the University of Kentucky, you know, a lot of the providers that I've come in contact with in the different specialties, we're all really passionate about cleft care. We're really passionate about making sure that these kids are well taken care of. We answer all questions and just walk them through the process. I think this is a very treatable defect. And like Dr. Liau said, these children will go on to live very normal lives and do the things that they want to do. But here at UK, we are extremely passionate and happy to help them navigate this part of their life.

Scott Webb: Dr. Liau, last word to you. What are your takeaways on cleft lip, palate, the work that you do, the lives that children will lead, services available to parents, all the above?

Dr. James Liau: I'm definitely going to echo Brooke. You know, we do have this theme and motto right into all the team members here. But I always start out and tell parents like, "Look, this is very fixable. This is not something that has to follow your child around. This is very fixable. Your job as a parent is to raise your child just like you would. And like we had mentioned before, there's no reason why this should hold your child back in any form or fashion.

Now, our job is to make sure that you can raise your child as a parent without having to worry about cleft care. We do all the heavy lifting with that. We do all the coordination, you know, we do obviously the medical care. But yeah, this is very flexible and we really look forward to being with your family and your child and getting them, as Brooke said, through the process of cleft care.

Scott Webb: Yeah. That's just a perfect way to end. It is totally fixable. And you do your jobs and we get to do our jobs as parents and see our kids grow up and live these normal lives that we all want for them. So I thank you both today for your compassion, your care, our better understanding of cleft lip and palate and everything that Kentucky Children's Hospital can do for parents and families. So you both stay well.

Dr. James Liau: Thank you.

Brooke Wilson: Thank you.

Scott Webb: You can find more information about cleft lip and palate on our website at ukhealthcare.uky.edu and search cleft. And that wraps up another episode of UK HealthCast from the University of Kentucky Healthcare. Please remember to subscribe, rate and review this podcast and all of the other University of Kentucky Healthcare podcasts. I'm Scott Webb. Stay well.