Surgical Repair of Cleft Lip and Palate

Surgical repair of cleft lip and palate is most often a staged procedure, with some surgeries being performed when your child is quite young, and other surgeries being performed when your child is older. The following sections will explain the timing of surgery, why surgery needs to be performed, and the anticipated results. The members of the Cleft Palate-Craniofacial Team at the John W. Keys Speech and Hearing Centers work together closely, taking a flexible approach to the timing of cleft repair, in order to optimize your child’s speech development and facial growth. The maxillofacial surgeon on the team will be happy to explain the surgeries that your child will need and the optimum timing.

Pre-Surgical Treatment of Cleft Lip

Cleft lip and cleft lip nasal deformities can be modulated with presurgical oral appliances that can improve the post-surgical lip and nasal appearance. By using an appliance to mold the cleft lip, upper jaw, alveolus, and nose prior to surgery, we can achieve better results. This may lessen the extent of surgery necessary and the number of subsequent procedures.

Initial Surgery

The first surgery that your baby will have is to close the cleft of the lip, repair the nose, and to rebuild the muscles around the mouth and nose. This is done after the baby has had time to grow and get somewhat stronger. Cleft lip repair is generally performed when the baby is 3 to 6 months of age. The actual surgery takes about an hour and a half and your child will generally stay in the hospital overnight. Parents are encouraged to spend the night in the same room as their child. The surgical team will provide care for your child while in the hospital and will explain how to care for the surgical repair at home.

Cleft Palate Closure

Closure of the cleft palate generally is performed between the ages of 12 and 15 months. The delayed sequence of this surgery will coincide with the initiation of speech development in the child. An intact palate is crucial to formation of certain syllables while speaking. By closing the cleft before the baby begins to talk, learning to speak can proceed in a more normal fashion.
The surgical procedure normally takes about an hour and a half. The tissues of the hard palate are advanced to close the gap between the mouth and the nose, and the muscles of the soft palate are reconstructed to meet at the midline.

The Teeth and Jaws

Clefts, which extend through the alveolus of the upper gums, can cause problems relating to the eruption of your child’s teeth. The oral and maxillofacial surgeon will work closely with the team’s orthodontist to coordinate the proper eruption and alignment of the teeth and jaws. Repair of an alveolar cleft often requires the placement of a bone graft and closure of the oral mucosa, usually between the ages of 5 and 11. This will help to properly support your child’s permanent teeth and aid in proper arch alignment.

Future surgeries

As your child grows, he may need more surgeries at different ages. It depends if problems arise and on the treatment plan that the Cleft Palate-Craniofacial Team at the John W. Keys Speech and Hearing Center has made for your child.

During your child’s mid-teens, he will have the final repairs to the lip and/or palate and a last repair of scar tissue. He may also need surgery to advance the upper jaw. As the child continues to grow and develop and when skeletal maturity is reached careful attention will be directed to dental occlusion and to the position of the upper and lower jaws. In some patients corrective jaw surgery (orthognathic surgery) is recommended to recreate a more normal occlusal relationship. This may mean that the upper jaw may be brought forward, the lower jaw brought backward or both procedures performed. The orthodontist and the oral and maxillofacial surgeon prior to the performance of these operative procedures carry out careful preoperative planning.

 Glossary