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Cleft Lip, Cleft Palate, Cleft Lip Nose

Explore what others have to say about Cleft Lip, Cleft Palate, Cleft Lip Nose with answers by Dr. Michael Bermant, MD.

Michael Bermant, MD
Board Certified by the American Board of Plastic Surgery

Reconstructive Reconstructive Surgery Hand Hand and Nerve Cosmetic Cosmetic aesthetic Congenital Breast Breast Breast Head & Neck plastic surgeon Skin Cancer skin cancer Microsurgery

This is the page where you can review questions and stories from patients, view the opinions of lay persons, and see answers from Dr. Bermant and other physicians. Do you want to ask a question, post an answer, or make a comment? Information E-mailed to me will be considered for posting.

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Cleft Lip, Cleft Palate, Cleft Lip Nose

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Subj: Re: SEEK information cleftlip

Dear Dr. Bermant,
I write to consult with you about surgery on a birth defect. My little niece, now 9 years old, has a minor upper lip defect. It does not show a big cleft, but only a clear line running from the bottom of her nose to her upper lip, and a very small "dip" at the upper lip. A doctor at Beijing's 301 hospital called this the first degree something (sorry I don't know exactly the terms), supposedly the lightest defect.

I suppose that an correction surgery is not a big one on this. However, I am not familiar with the current level of expertise on this kind of surgery in China and which doctors are the best on it in China. From the internet, I know you have contacts with Chinese doctors on this subject, and so I would like to hear your opinion on it.

I am also considering to have her come to the united states to take the surgery. But I'm not sure about the cost and if we can afford it. Would you please give me an estimate of the cost of your service and others in general. I greatly appreciate your help to us and to this little girl. I look forward to hearing from you.

Sincerely,...

Dr. Bermant responds:

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

Microform cleft lip (incomplete) has several subdivisions. The type surgery depends on the extent of the defect. Involvement to the nose may be more than a Type !. If the defect is a Type III then the surgery may be more extensive. For my patients, surgery is usually done with 0-2 days hospitalization. It depends when the child is taking food well. My costs may not be so bad, but you have the hospital's cost in addition. We do see patients from far away.

There are excellent plastic surgeons in China. I met several during my time there in Beijing and Shanghai. I have also heard wonderful things about some of the centers in Canton.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD


Re: Short Palate

I understand that you are a board certified surgeon. Please read the following letter and if you could help me out in anyway i would be more than grateful to you. thank you so much. Here's the story; My mother had uppp surgery (knife not laser) to correct her snoring and sleep apnea condition in January. Immediately after surgery she knew something was wrong. She was having fluids going up her nose every time she swallowed. Her ENT told her the symptoms would go away. He was wrong. Two months later she still had that symptom except now she had developed more. These new symptoms include; snapping in the back of

her throat after swallowing (as a result of scar tissue), food gets stuck right below her nasal canal because the scar tissue has formed a damn, she has a constant build up of mucous which clumps together and falls down her throat causing her to choke, she has a constant dry cough as well as a constant sore throat, she also has problems sleeping the whole night through (which she never had when she used to snore!). Her ENT in fear of a law suit, told her that it was all in her head. My mother then sought a second and third opinion. Both of these doctors confirmed my mother's suspicions that her surgeon had cut her palate way too short, which was causing the fluids to go up her nose (because the palate was not closing off the opening completely). The only good thing was that she has stopped snoring.

Now it is six months since her surgery and all of her symptoms are still the same if not worse. My mother is suffering psychologically. She is extremely depressed all of the time because she feels her life is not worth living like this. Since then she has spoken to a few surgeons and doctors in my area (Boston) and no one will help her. She at least thought that she would be able to get this fixed, but no one will do it. She believes that all of the surgeons are afraid to touch her because they don't want to mess her up even more. They say that she has too much scar tissue, and there is not much palate to work with. Nobody is willing to help her. She has given up all hope and is miserable all of the time. My mother used to be the happiest person I knew, even when things were at their worst, so I know that this has to be the most horrible thing that has ever happened to her. She is willing to travel anywhere in the United States if she can find a surgeon that will help her, the thing is she doesn't believe that there is one out there, but I do, and I need anyones help that I can get. there has to be other people out there who have had this happen to them, and gotten it fixed. Any information would be appreciated beyond belief, and it can be e-mailed to me as soon as possible at:...

The worst part of this all is that my mother thinks that she is snoring again. Somebody please help me find someone to help her. thank you,

Dr. Bermant responds

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

A short palate can be a complication of surgery to correct snoring and can cause symptoms like you are describing. Short or deficient palates can also be created from cancer surgery, trauma, and from birth defects.

Some people are born with deficient palates (cleft palate) and may need much help to develop swallowing skills, speech patterns as well as other issues. Many teams of doctors and care providers join to evaluate the various aspects and treat the problems. Typical teams have plastic surgeons, ear nose and throat surgeons, oral surgeons, prosthadontists, audiologists, speech pathologists, social workers, and sometimes psychologists.

A good cleft lip and palate team may be the place to start. The problem needs a thorough evaluation. They may consider a swallowing study where a xray movie shows how effective each structure is during swallowing. Other evaluations they suggest may include nasal or oral endoscopy where a tube lets the surgeon see the palate in action directly.

Sometimes swallowing therapy alone can help someone compensate. Palate defects may also be improved with various surgeries. Depending on the problem, the hard and soft palate may need to be pushed back. Other problems may need a band of tissue brought from the back of the throat and attached to the remaining palate. These repairs and subsequent therapy may restore some, most or all of the functional loss.

I hope this information proves of some use. If you can, sit down with her doctors and ask for help getting to a cleft palate team. If not the American Society of Plastic Surgeons can be reached by calling 1-800 635-0635. They will send some preliminary information and a list of board certified surgeons in your region.

Michael Bermant, MD


Subj: Re: unfortunate miscommunication

Situation & Question:

1st: I'm a 28 yr old male. I was born w/ a cleft lip (not pallet). At 16 I had my 5th operation to correct the deformity. The base of my nose was slightly crooked, so the surgeon suggested that the operation include corrective surgery on the nose too. While he examined it he suggested that he also trim the "knot" off of my nose. My nose had a straight profile, but a visibly wide section of bone in the middle. That was all the discussion we had about it. No sketches, no computer renderings, etc. It was an unfortunate miscommunication because when the bandages came off, I discovered that he had removed more than 2cm of bone from the bridge (front) of my nose, and none from the sides. The result is a nose that is still appears to be wide in the middle and has a very concave profile. Quite frankly, it looks like the nose of a 7 yr old boy.

That's the situation; my question is: can a nose profile that has been reduced by 50% be reconstructed?

Dr. Bermant responds

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

It is difficult to comment without an examination and evaluation. Some nasal deformities can be improved by returning material to the site where material was removed. Cartilage and bone from other parts of your body are common sources for the building material.

Not all doctors do computer evaluations. Some use drawings. Communication by whatever fashion however is important. We cannot always read the mind of the doctor nor the doctor read the mind of the patient. Go back to your doctor to further discuss these issues. Your doctor has been in your nose before.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD


Subj: Re: cleft palate

Dr. Bermant,

I was born with a bilateral cleft lip and palate.I had many operations in my childhood to correct it, as well as speech therapy. I am now 22 years old and still feel that my speech is too nasal. Is there a surgical procedure which can reduce or eliminate the nasality ? Thank you for your time and help.

P

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

I cannot comment without an evaluation and examination. There are several problems that can still be present to give the symptoms you describe. A fistula (abnormal connection between two cavities) can exist between your nose and palate that can cause nasal speech. Palate function that only partially closed the back of the mouth can also cause nasal speech. Other defects also can cause nasality. Sometimes these problems can be improved but several evaluations may be necessary before that can be determined.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD

Subj: Re:cleft_lip_palate.html

Hello

My name is D and I am recently a new mother of a cleft affeted child. I have a few questions I was hopeing someone may be able to answer if not perhaps you cnan assist me in finding someone who may be able to help. My first question is. Do you have a support goup in my area . I am located in Ontario Canada? Is there some information you may be able to send me? What are things I should be aware of . This is all very new to me and I really have no Idea what the next few months,Have in store for me and my new son.

I am currently using ther herberman feeder. I am having alot of trouble with the nipples terring after only one week of use. These nipples are costing 11.00 /nipple. Is this normal are there any other nipples that I may subbtitue for these thay may be more reliable. I am finding the expense a little much .The company that produces these nipples is "Medela" The feeder is working very well for my son. I really need a more reliable nipple.

-- L

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

Feeding a child with cleft palate sometimes takes a little adapting. One very nice resource in from widesmiles, an online resource for cleft families. The page with specific information about feeding is:

http://www.widesmiles.org/NewFeed.html

There are usually more than one working option for each mother and child. Some longer nipples can work. They sometimes need the opening modified to a larger size. Leaking from the neck of the bottle / nipple is sometimes a factor. A local support person, doctor, or nurse is a real benefit. You should have a plastic surgeon / cleft lip-palate team evaluation to help organize your educational experience.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD


Subj: Re: Our unborn child

Hi, My name is Shoshana and I live in Israel with my husband Allan and 2 kids- a boy Jake and a girl Ayelet. I am writing to you in respect to my current pregnancy. I am now about 23 weeks due sometime between the last day of January, first week of February. At my 20-21 week ultrasound the doctor noticed a bilateral cleft lip and an unknown cystic mass in the lower abdomen. I was then sent to a specialist who detected a bilateral cleft lip AND palate, the same mass and only 1 kidney. The single kidney is working fine as they see she (it's a girl) is peeing and there is a lot of amniotic fluid. At 21 weeks I had an amniocentesis done as the doctors recommended. I am due to get the results back in about 10 days to 2 weeks. Sunday I am scheduled for another ultrasound. I realize not all of these problems are in your field, but we would really appreciate any advise you can offer regarding the cleft lip and palate or any of the other problems. Does this sound as if it can be associated with any syndrome in particular? The option of terminating the pregnancy has been brought up by both family and medical proffessionals. At this point, I am leaning towards continuing the pregnancy although my husband really isn't sure what to do. Thank you for listening and I look forward to hearing from you soon. Have a nice weekend.

-S.

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

The cleft lip / palate patient and parents can lead wonderful lives. The cleft problem is probably not going to be a major factor in your decision. Cleft surgery is common place and has been managed by many. There are roadblocks ahead and it is not uncommon to face the unknown with fear. That is why I like to see the parents of new cleft lip babies in the hospital before they even bring their child home. Setting up the learning process and helping with understanding seems to make it much easier for the families of my patients. Your hospital is a little far for me to do that, and your child would have been the youngest cleft child to be a part of this process. With the improvements in ultrasound, finding a cleft lip / palate during pregnancy has become more common.

Your E-mail greatly disturbed me, enough to do a drawing about your problem. My plastic surgery started with an attempt to learn more and develop an animal model to create cleft lip before birth. We know that repair of such deformities while the patient is still in the mother's womb will result in scarless surgery and possibly a lesser deformity. The goal is getting closer with an animal model reported at the last meeting of the American Society of Plastic & Reconstructive Surgeon's meeting last month in San Francisco California. I do not know of anyone world wide offering such intervention, but some day that surgery may become a possibility.

There are always other factors that go into making the decision you ask, most outside my expertise. You will need to set up your support team to help with such matters. Your doctors, clergy, and yourselves are the best members of that team. The learning process can start with the Internet. I have yet to upload my cleft cases on my web page. I have done my site by myself and there are only so many hours in the day. There is a very nice site that has much to start with for cleft education:

http://www.widesmiles.org

Your doctors will be a better source since they can take the generalizations that have to be the nature of a basic education tool, and help make them the specifics you need for you.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD

 

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