Surgical Repair of Cleft Lip and Palate

Surgical repair of a cleft lip and palate have medical benefits beyond the cosmetic. Repairing a cleft lip and palate will provide your infant with improved ability to nurse or drink from a bottle while also helping to facilitate optimal speech. Surgical repair of a cleft lip and palate is not a single procedure, but rather a series of surgeries to help maximize the benefit to your child while minimizing the risks for complications.

Lip Adhesion

For babies born with a complete cleft lip, the first surgical procedure is likely to be a lip adhesion. This is a preliminary surgery that is usually performed between 2 and 4 weeks of age. The aim of the surgery is to convert a complete cleft lip (wide unilateral or bilateral complete cleft) to an incomplete cleft lip.

By performing this surgery now, the hope is to reduce incision tension (something that occurs during the healing process) when the cleft lip repair is performed later. Reducing tension will reduce the risks for problems after the next surgery.

Possible disadvantages to having this procedure performed include risks commonly associated with any surgical procedure requiring general anesthesia, such as nausea and vomiting, breathing problems and in rare cases even death. In relation to your child's cleft lip, the additional development of scar tissue may actually interfere with later procedures to repair the lip, however, this is not usually the case.

Cleft Lip Repair (Cheiloplasty)

Cleft lip repair, or cheiloplasty, is typically performed between 4 and 6 months of age. The goal of this surgery is to complete the cosmetic repair of the lip and to aid in nursing or feeding and later speech development. Your surgeon will attempt to adjust the scar that was formed from previous surgeries.

In order to fully identify when your child is ready to have this procedure, some doctors use a scale called the rule of tens:

• your child is at least 10 weeks old
• your child weighs at least 10 pounds
• your child has a hemoglobin of at least 10 grams

Following the rule of tens may cause your child to deviate from the standard 4- to 6-month range for cleft lip repair but will help minimize complications from the procedure. Depending on your surgeon and your child’s cleft lip, there are several surgical approaches that can be used to perform your child’s cleft lip repair, including:

• Bardach
• Millard Rotation-Advancement (one of the most popular techniques)
• Mulliken
• Tennison-Randall
• Straight-line closure (this is not a common method for cleft lip repair)

Some physicians will use modified versions of the techniques listed above. Decisions on what method to use may be decided by the surgeon's preference or by your child’s type of cleft lip and palate. Through the various techniques, your surgeon will attempt to create:

• the lip's natural “Cupid’s Bow” shape
• adjust lip structure for natural distance from nose to lip
• mask scar in normal structures of the lip
• attempt to normalize symmetry of the nostrils

Cleft Palate Repair (Palatoplasty)

The timing for performing palatoplasty is important because of normal growth and development for infants. Performing the surgery too early will not allow for proper growth of the maxilla and face. However, not performing the surgery early enough may inhibit the development of speech. It is recommended that cleft palate repair be performed between 9 and 16 months of age. As with the cleft lip repair, there are many different techniques that your physician may choose to perform palatoplasty, including:

• Bardach for complete cleft palate repair
• Furlow for second cleft palate repair
• Schweckendiek
• V-Y pushback for second cleft palate repair
• Von Langenbeck soft palate repair

The goals of cleft palate repair are different in some aspects than the cleft lip repair. Much of the cleft lip repair is cosmetic in nature while repairing the cleft palate is more focused on the structure of your child's mouth. Surgical repair of a cleft palate can decrease the risk for ear infections, delays in speech development, and help in maintaining normal growth and global development. You should also realize that as your child matures, additional surgeries may be necessary including:

• nasal surgery (rhinoplasty)
• palate expansions
• orthodontics