Cleft lip and cleft palate are among the most common birth defects. Incomplete formation of the lip (cleft lip) or the roof of the mouth (cleft palate) may occur alone or together. These conditions may vary in severity and affect one or both sides of the face.
Cleft lip and roof of the mouth occur in the early stages of development before your child is born. During fetal development, some parts of the upper lip or roof of the mouth may not form normally. Cleft lip and palate repair is a type of plastic surgery that corrects these developmental abnormalities, restores normal function and creates a more natural appearance for the patient. Most clefts can be repaired with special plastic surgery techniques, increasing the child’s ability to eat, speak, hear, and breathe, while creating a normal appearance and function.
In cleft lip or palate repair, an initial evaluation by a team of specialists is essential. Together, this team should develop a treatment plan that includes surgical repair of the cleft, speech rehabilitation, and dental correction. This team may include the following:
Plastic surgeon, pediatrician, pediatric dentist, otolaryngologist, speech therapist, speech pathologist, genetic counselor, social worker
Cleft lip repair surgery is a specialized procedure that aims to not only close the defect but also restore normal function to your child. Cleft lip repair, also called Cheiloplasty, involves restoring a normal appearance with the following steps:
Repairing the lip muscles to allow for normal facial movements, speaking, and eating
Closing the cleft so that the scar is in the natural lip structure
Shaping the Cupid’s bow (the curved area in the center of the upper lip)
Ensuring sufficient distance between the upper lip and the nose
Repairing the outer edge or base of the nose to create a natural appearance
Since the palate forms both the roof of the mouth and the floor of the nose, the following considerations should be taken into account when repairing a cleft palate
Relationship of the palate with the auditory canal
Dental growth and normal jaw relationship
Since the presence of a cleft also affects the shape of the nose, further procedures may be needed for the following purposes:
Creating symmetry between the nostrils
Creating the natural length of the columella (the tissue that separates the nostrils)
Increasing the angle of the nasal tip to prevent the tip from flattening or pulling it downward
The timing of cleft repair depends on your child’s individual circumstances. Generally, lip repair is done between 2 and 4
months, when the child’s feeding and growth are stable.
Cleft palate repair is usually done a little later, around 9 to 18 months of age. Cleft repair may be delayed until other more serious problems, such as heart or lung disorders, are treated.
The success and safety of your child’s cleft surgery begins with a consultation with your plastic surgeon, and depends largely on your honesty.
Be prepared to discuss
Your concerns, and your child’s assessment
The options available for repairing the cleft lip or palate
The possible outcomes of surgery and the risks and complications
The chosen treatment method
Be honest about your concerns regarding your child, as well as about the plastic surgeon’s ability to resolve his or her problems. The success and safety of the surgery and your overall satisfaction with the procedure require that you
honestly share your concerns
Provide your child with a complete health history, including medications, vitamins, and herbal supplements.
Follow your plastic surgeon’s instructions carefully.
Before surgery, your plastic surgeon will discuss the following with you:
Preoperative considerations, diagnostic tests, and medications
Day-of-surgery instructions and medications
Special information about anesthesia
Your plastic surgeon will also explain where the surgery will be performed. Cleft repair is usually performed in a hospital setting under general anesthesia.
Sometimes, your child may be given an oral appliance called an obturator to use before the cleft lip is repaired. This helps your child eat and helps maintain the arch of the lip before surgery.
What happens during cleft lip and palate surgery?
Stage 1 – Anesthesia
General anesthesia is used to keep your child comfortable during surgery.
Stage 2 – Incision
The goal of cleft lip surgery is to close the area of the lip separation and restore normal function, structure, and appearance to the upper lip. Surgical incisions are made on both sides of the cleft lip and flaps are created to be brought together and sutured to close the cleft lip.
Cleft palate repair requires repositioning of tissues and muscles to close the cleft palate and create a roof of the mouth. Surgical incisions are made on both sides of the cleft lip and flaps are used to reposition the muscles and hard and soft palate components. The repair site, usually in the midline of the roof of the mouth, is then closed with sutures, allowing sufficient length of the palate for normal nutrition and speech, as well as continued growth throughout life.
Step Three – Closing the Incisions
Cleft lip and palate incisions can be closed with absorbable or non-absorbable sutures.
Note: It is important to note that although a cleft can be repaired in one surgery, treatment for a child born with a cleft will continue throughout adolescence, and sometimes even adulthood, and as the child grows, secondary surgeries may be necessary to improve function or appearance.
Step Four – Observing the Results
Usually, the external scars from cleft repair will be in the natural contours of the upper lip and nose. Over time, these will fade and your child’s ability to grow and function normally will improve.
The decision to have cleft surgery is a very personal one, and your plastic surgeon will explain the benefits, goals, possible risks, and complications of the procedure to you. You will be asked to sign a consent form indicating that you fully understand the type of surgery, other options, and possible risks and complications.
Bleeding (hematoma)
Problems in healing incisions
Irregular healing of scars such as contractures (tissues contracting or pulling together)
Irregularity or asymmetry remaining
Risks of anesthesia
Sensitivity to glue, sutures, blood products, topical products, and injectable medications
Damage to deeper elements (such as nerves, blood vessels, muscles, and lungs, which may be temporary or permanent)
Possibility of needing re-surgery
After surgery, your child may have a dressing or bandage placed over the incisions outside their mouth.
You may be given specific instructions, such as:
How to care for the surgical site.
Medications, either topical or oral, to help heal the wound or reduce the risk of infection.
Pay special attention to your child’s general health, and when to see your plastic surgeon after surgery.
Your plastic surgeon or the ward staff will instruct you on how to feed your child and any special restrictions or activities. Don’t be surprised if you see your child in a hand splint in the recovery room. These splints help prevent your child from hurting the surgical site during the healing period. These splints can be removed temporarily several times a day, as long as you are careful not to touch the surgical site or suck your thumb. Your child’s discomfort should be relieved with painkillers. Some stitches may need to be removed after surgery, if necessary. Wound healing will continue over a few weeks as swelling subsides. After surgery, strict sun protection is essential to prevent abnormal scarring.
