Surgical repair of a cleft lip and palate have medical benefits beyond the cosmetic ones. 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.
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, as well as the development of scar tissue that may actually interfere with later procedures to repair the lip.
Cleft Lip Repair (Cheiloplasty)
Cleft lip repair, or cheiloplasty, typically takes place between 4 to 6 months of age. The goal of this surgery is to complete the cosmetic repair of the lip, and to aid in nursing, feeding and later speech development. Your surgeon will attempt to adjust the scar.
In order to fully identify when your child is ready to have this procedure, some doctors use a scale called the "rule of tens," meaning that:
- 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:
- Millard Rotation-Advancement (one of the most popular techniques)
- 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)
There is much controversy over what is the best age to perform a palatoplasty. Despite the controversy, this surgery currently has a lot of success.
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. Current evidence recommends cleft palate repair 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
- 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 internal structure. The procedure can decrease the risk for ear infections and delays in speech development, and also 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) and palate expansions.
American Society of Plastic Surgeons. (2011). Cleft Lip and Palate Repair: Correct Abnormal Development. Accessed: May 16, 2012 from http:// www.plasticsurgery.org/reconstructive-procedures/cleft-lip-and-palate.html? sub=More%20than%20a%20cosmetic%20repair#content
Goldenberg, D. & Goldstein, B.J. (2011). Handbook of Otolaryngology – Head and Neck Surgery. New York City, NY: Thieme Medical Publishers, Inc.
Randall, P. (1965). A Lip Adhesion Operation in Cleft Lip Surgery. Plastic and Reconstructive Surgery. 35(4). pp. 371-376.
Salyer, K.E., Rozen, S.M., Genecov, E.R. & Genecov, D.G. (2005). Unilateral Cleft Lip – Approach and Technique. Accessed: May 16, 2012 from http://www.ncbi.nlm.nih.gov/ pmc/articles/PMC2884747/