What is cleft lip and palate repair surgery?

 

 

Cleft lip (cheiloschisis) and cleft palate (palatoschisis) are among the most common birth defects affecting children.

The incomplete formation of the upper lip (cleft lip) or roof of the mouth (cleft palate) can occur individually, or both defects may occur together. The conditions can vary in severity and may involve one or both sides of the face.

 

More than a cosmetic repair

Surgery to repair a cleft of any kind is a highly individualized procedure that's intended to not only close the defect, but also to insure your child's ability to function and grow normally.

Cleft lip repair, also called cheiloplasty, includes reconstruction of a more normal appearance, namely:

  • Closure of the cleft resulting in a scar located in the normal structures of the upper lip
  • Formation of a cupid's bow (the curve at the center of the upper lip)
  • Considerations for adequate distance between the upper lip and nose

 

Because the palate creates the floor of the nasal cavity, considerations in repairing a cleft palate include:

  • Allowing for normal growth, function and speech development
  • Relation of the palate to the auditory canal and hearing
  • Development of the teeth and jaw alignment

 

Where the cleft also affects the shape of the nose, additional procedures may be recommended to:

  • Achieve symmetry between the nostrils
  • Create adequate length of the columella (the tissue that separates the nostrils)
  • Increase the angle of the nasal tip, to avoid a flattened nasal tip or one that pulls downward

 

When should my child have the surgery?

The timing of the cleft repairs depend on the individual circumstances of your child.

  • Cleft lip repairs are initially performed when a child is at least 10 weeks of age and 10 pounds in weight and has a hemoglobin (or blood count) of at least 10.
  • Cleft palate repairs are generally performed when a child is somewhat older, from 9 to 18 months of age.
  • Cleft repair may be delayed in order to treat other, more life-threatening problems that may be present such as a heart or lung disorder.

 

Cleft repair surgery procedure steps

 

Step 1 – Anesthesia

Medications are administered for your child's comfort during the surgical procedures. The choices include intravenous sedation and general anesthesia. Your doctor will recommend the best choice for your child.

 

Step 2 – The incision

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.

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, speech development and continued growth throughout life.

 

Step 3 – Closing the incisions

Cleft lip and palate incisions can be closed with removable or absorbable sutures.

A special note: It is important to understand that while a cleft may be surgically repaired in a single plastic surgery procedure, treating a child born with a cleft continues through adolescence and sometime even adulthood. As a child grows, secondary plastic surgery procedures to improve function and appearance may be required.

 

Step 4 – See the results

The resulting external scars of a cleft repair are generally positioned in the normal contours of the upper lip and nose. Over time, these will fade and your child's ability to grow and function normally will continue to improve.

 

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