Plastic Surgery

Cleft lip / palate surgery

What is the Cleft lip / palate surgery?

Cleft lip (cheiloschisis) and cleft palate (palatoschisis), which can also occur together as cleft lip and palate, are variations of a type of clefting congenital deformity caused by abnormal facial development during gestation. A cleft is a fissure or opening—a gap. It is the non-fusion of the body's natural structures that form before birth. Approximately 1 in 700 children born have a cleft lip and/or a cleft palate. Clefts can also affect other parts of the face, such as the eyes, ears, nose, cheeks, and forehead.

If the cleft does not affect the palate structure of the mouth it is referred to as cleft lip. Cleft lip is formed in the top of the lip as either a small gap or an indentation in the lip (partial or incomplete cleft) or it continues into the nose (complete cleft). Lip cleft can occur as a one sided (unilateral) or two sided (bilateral).

Palate cleft can occur as complete (soft and hard palate, possibly including a gap in the jaw) or incomplete (a 'hole' in the roof of the mouth, usually as a cleft soft palate).

A cleft lip or palate can be successfully treated with surgery, especially if performed soon after birth or in early childhood.

What is the procedure?

Within the first 2–3 months after birth, surgery is performed to close the cleft lip. For cleft lip surgery, your child will have general anesthesia. While surgery to repair a cleft lip can be performed soon after birth, often the preferred age is at approximately 10 weeks of age. If the cleft is bilateral and extensive, two surgeries may be required to close the cleft, one side first, and the second side a few weeks later. The most common procedure to repair a cleft lip is the Millard procedure.

The goal of cleft lip surgery is to close the separation in the lip and to provide a more normal function, structure and appearance to the upper lip. Incisions are made on either side of the cleft to create flaps of tissue that are then drawn together and stitched to close the cleft.

Often an incomplete cleft lip requires the same surgery as complete cleft. This is done for two reasons. Firstly the group of muscles required to purse the lips run through the upper lip. In order to restore the complete group a full incision must be made. Secondly, to create a less obvious scar the surgeon tries to line up the scar with the natural lines in the upper lip (such as the edges of the philtrum) and tuck away stitches as far up the nose as possible. Incomplete cleft gives the surgeon more tissue to work with, creating a more supple and natural-looking upper lip.

Cleft palate can also be corrected by surgery, usually performed between 6 and 12 months. The repair of a cleft palate requires careful repositioning of tissue and muscles to close the cleft and rebuild the roof of the mouth. Incisions are made on either side of the cleft and specialized flap techniques are used to reposition muscle and the hard and soft components of the palate. The repair is then stitched closed, generally at the midline of the roof of the mouth, providing enough length of the palate to allow for normal feeding and speech development, and continued growth throughout life.

Approximately only 20–25% require one palatal surgery to achieve a competent velopharyngeal valve capable of producing normal, non-hypernasal speech. However, combinations of surgical methods and repeated surgeries are often necessary as the child grows. One of the new innovations of cleft lip and cleft palate repair is the Latham appliance. The Latham is surgically inserted by use of pins during the child's 4th or 5th month. After it is in place, the doctor or parents turn a screw daily to bring the cleft together to assist with future lip and/or palate repair.

What kind of result can you expect?

The outcome of child’s initial cleft lip and/or cleft palate repair will make a vast difference in his or her quality of life, ability to breathe, eat and speak. However, secondary procedures may be needed for functional reasons or to refine appearance. Even though the scars of a cleft lip repair are generally located within the normal contours of the face, they will always be visible.

A child who had a cleft palate repair may need to see a dentist or orthodontist. The teeth may need correcting as they come in.

Hearing problems are common in children with cleft lip or cleft palate. Child should have a hearing test early on, and it should be repeated over time.

Child may still have problems with speech after the surgery. This is caused by muscle problems in the palate, and speech therapy can help.

Recovery period and recommendations

After surgery, dressings or bandages may be placed on incisions outside child’s mouth.

The surgery wound must be kept very clean as it heals. It must not be stretched or have any pressure put on it for 3 to 4 weeks. Until the wound heals, child will be on a liquid diet and will probably have to wear arm cuffs or splints to prevent picking at the wound.

Child’s discomfort can be controlled with pain medication. If necessary, sutures will be removed following surgery. Healing will continue for several weeks as swelling resolves.

Possible side effects and complications

Some of the risks of the surgery include bleeding (hematoma), infection, poor healing of incisions, irregular healing of scars including contracture (puckering or pulling together of tissues), residual irregularities and asymmetries, anesthesia rinks, allergies to tape, suture materials and glues, blood products, topical preparations or injected agents, damage to deeper structures - such as nerves, blood vessels, muscles, and lungs - can occur and may be temporary or permanent, possibility of revisional surgery.

Specific problems these surgeries may cause are that the bones in the middle of the face may not grow correctly and/or the connection between the mouth and nose may not be normal.






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