The University of Oklahoma
	An Interdisciplinary Team Approach to Cleft Lip, Cleft Palate and Craniofacial Problems

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 10 weeks old. 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 many important speech sounds. By closing the cleft before the baby begins to talk, learning to produce those speech sounds 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 (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. Traditionally bone has been harvested from the hip and is still used to this day. One of the new materials that may be used for bone grafting is Bone Morphogenic Protein. This protein is synthesized to induce humans to form bone in the area the protein is placed. By using this bone inducing protein kids can play normally after surgery because they have not had to undergo the painful hip surgery. Discuss the use of BMP with your Surgeon to see if it is right for you.

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.

	Your child will be screened regularly by a speech/language pathologist to monitor his speech development. If air is escaping from your child’s nose (Velopharyngeal insufficiency), this may need to be surgically repaired.
	Before your child reaches school age, he may have a nasal tip reconstruction (repair of the end of the nose) and a revision of the lip scar.