Cleft Lip & Palate

During early pregnancy, separate areas of the face develop individually and then join together, including the left and right sides of the roof of the mouth and lips. However, if some parts do not join properly, sections don’t meet and the result is a cleft. If the separation occurs in the upper lip, the child is said to have a cleft lip.

A completely formed lip is important not only for a normal facial appearance but also for sucking and to form certain sounds made during speech. A cleft lip is a condition that creates an opening in the upper lip between the mouth and nose. It looks as though there is a split in the lip. It can range from a slight notch in the colored portion of the lip to complete separation in one or both sides of the lip extending up and into the nose. A cleft on one side is called a unilateral cleft. If a cleft occurs on both sides, it is called a bilateral cleft.

A cleft in the gum may occur in association with a cleft lip. This may range from a small notch in the gum to a complete division of the gum into separate parts. A similar defect in the roof of the mouth is called a cleft palate.

Cleft Palate

The palate is the roof of your mouth. It is made of bone and muscle and is covered by a thin, wet skin that forms the red covering inside the mouth. You can feel your own palate by running your tongue over the top of your mouth. Its purpose is to separate your nose from your mouth. The palate has an extremely important role during speech because when you talk, it prevents air from blowing out of your nose instead of your mouth. The palate is also very important when eating. It prevents food and liquids from going up into the nose.

As in cleft lip, a cleft palate occurs in early pregnancy when separate areas of the face have developed individually do not join together properly. A cleft palate occurs when there is an opening in the roof of the mouth. The back of the palate is called the soft palate and the front is known as the hard palate. A cleft palate can range from just an opening at the back of the soft palate to a nearly complete separation of the roof of the mouth (soft and hard palate).

Sometimes a baby with a cleft palate may have a small chin and a few babies with this combination may have difficulties with breathing easily. This condition may be called Pierre Robin Sequence.

Since the lip and palate develop separately, it is possible for a child to be born with a cleft lip, palate or both. Cleft defects occur in about one out of every 800 babies.

Children born with either or both of these conditions usually need the skills of several professionals to manage the problems associated with the defect such as feeding, speech, hearing and psychological development. In most cases, surgery is recommended. When surgery is done by an experienced, qualified oral and maxillofacial surgeon such as Dr. Hishmeh, the results can be quite positive.

Cleft Lip Treatment

Cleft lip surgery is usually performed when the child is about ten years old. The goal of surgery is to close the separation, restore muscle function, and provide a normal shape to the mouth. The nostril deformity may be improved as a result of the procedure or may require a subsequent surgery.

Cleft Palate Treatment

A cleft palate is initially treated with surgery safely when the child is between 7 to 18 months old. This depends upon the individual child and his/her own situation. For example, if the child has other associated health problems, it is likely that the surgery will be delayed.

The major goals of surgery are to:

  1. Close the gap or hole between the roof of the mouth and the nose.
  2. Reconnect the muscles that make the palate work.
  3. Make the repaired palate long enough so that the palate can perform its function properly.

There are many different techniques that surgeons will use to accomplish these goals. The choice of techniques may vary between surgeons and should be discussed between the parents and the surgeon prior to surgery.

The cleft hard palate is generally repaired between the ages of 8 and 12 when the cuspid teeth begin to develop. The procedure involves placement of bone from the hip into the bony defect, and closure of the communication from the nose to the gum tissue in three layers. It may also be performed in teenagers and adults as an individual procedure or combined with corrective jaw surgery.

What Can Be Expected After The Surgery?

After the palate has been fixed, children will immediately have an easier time in swallowing food and liquids. However, in about one out of every five children following cleft palate repair, a portion of the repair will split, causing a new hole to form between the nose and mouth. If small, this hole may result in only an occasional minor leakage of fluids into the nose. If large however, it can cause significant eating problems, and most importantly, can even affect how the child speaks. This hole is referred to as a “fistula,” and may need further surgery to correct.

Sam B. Hishmeh, DDS, PA - Oral & Maxillofacial Surgery

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I have never been in more capable hands as I was with Dr. Hishmeh. I have been seen by him many times and NOT once has he left me ill informed, or in needless pain.

- Gary S

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The experience was very good. The office staff is well organized and prepared for my visit. The doctor and his assistant were pleasant, precise, and did a great job explaining the procedure. The actual procedure took less time than I expected, I was surprised at how early I was on my way back home. I would recommend this office for anyone in need of the services they offer.

- Randy G

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Dr. Hishmeh and his staff were amazing! I am terrified of dental work and everyone in the office was so kind and put even me at ease. I had a fractured tooth under a crown causing alot off pain. The procedure was quick and painless. I could not be happier with the results. The service I received was top notch, and the level of caring and compassion are off the charts. I highly recommend their services.

- christine t

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It's not often you can say that you had a great experience at the dentist's office, but I did today with Dr. Hishmeh. I was faced with a difficult extraction of a damaged tooth, but Dr. Hishmeh explained the procedure thoroughly before we started and put my mind at ease. The procedure went very smoothly and i had very little discomfort - I'm looking forward to my next appointment and a new implant.

- Brian B

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Appreciated the care provided.

- Freddie A

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It was a pleasant experience given it was a dental office visit. The collective personality and efficiency displayed by Dr. Hishmeh and supporting staff was exceptional and, moreover, much appreciated.

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Very nice experience for an elderly patient.

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The staff and the doctor all displayed a high degree of knowledge and caring. Great sense of humor, immediately made me at ease

- Jacob C

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Dr. Hishmeh made himself available for me with very little notice. He has a sense of humor and put me at ease. Best of all, he and his staff were very professional and most importantly, very competent. As a health professional myself, I highly recommend Dr. Hishmeh.

- Maryanne M

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Somewhat of an emergency visit and staff was very good about calling me with a cancellation time so I could get in sooner. There was a little bit of a wait beyond my scheduled appointment time but it really wasn't an issue.

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All were very prophessional and made me less stressed. I would recommend them to my friends.

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I strongly recommend this practice to anyone that requires any kind of oral care. My extraction took less than five minutes. I felt no pain during the procedure and very minimal discomfort after the extraction. AWESOME JOB

- William D

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They well done . They wonderful team and smart Doctor

- Amany B

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The staff were professional, knowledgeable, and efficient. Dr. Hishmeh was great - I had two teeth removed and didn't feel a thing. I was in and out in under 30 minutes. Dental work is never fun, but Dr. Hishmeh and his staff were wonderful to work with. I would absolutely return if I required further services.

- Danielle W

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Staff was outstanding and Dr. Sam is the best! Didn't feel a thing! Will be back for future work if needed. Highly Recommend.....

- Greg W

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In and out in less than 40 minutes for a tooth extraction

- ADAM L

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The physician, office staff, and all aspects of our experience have been a 5 out of 5. Dr. Sam and his staff are adults, they care, they are knowledgeable, they listen, they care, and they respond. We will be sure to do all of our oral needs with them and will be sure to let our dentists know to refer their patients here as well. Thank you for being such a great service to your clients and for bringing adults with experience to the office.

- David M

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I would highly recommend to anyone Dr.Sam Hishmeh and staff for dental service.

- James

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Had an Evaluation one day in Silver Spring and an extraction the following day in Clarksville. With the current pandemic, both facilities met all recommendations. The staff is personable, professional and efficient. Dr. Hishmeh was the Best. He explained each step of my procedure and what to expect which made me very comfortable. The procedure was quick and far better than anticipated.

- Nancy H

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Best staff--wonderful doctor-- No pain during extraction of 6 teeth!

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