Cleft lip and palate repair

Cleft lip and palate are relatively common birth defects and the techniques for repair are well developed and widely practiced.   All aspects of cleft lip and palate are very treatable and excellent results can be achieved.  The repair of cleft lip and palate usually requires a series of operations that begin in early infancy. 

In this section, I will outline a few of the concepts that guide our treatment of children with clefts.

First, we want to provide for as normal a facial appearance as possible.  This requires that we use good planning, the best surgical techniques, and the use of pre and post-surgical orthodontics to provide excellent form.

Second, we want to plan surgical timing and technique to provide the best function possible.

Third, we want to provide the best results with the fewest operations possible.  This also implies planning surgery to prevent complications that require re-operation.

All children with clefts require: 1) repair of the lip, 2) repair of the hard and soft palate and gumline, 3) placement of a bone graft in the alveolus (bone of the gumline).

Many surgeons prefer to group these surgeries so that all of the repairs are done by two years of age.  This is a good approach because it “completes” the repair process very early in life, before a child can remember any of the surgeries.

Some surgeons prefer to use a “staged approach” to repairing clefts.  This means that the repair of the cleft lip, hard palate, and soft palate are done at different times in different surgeries over a longer period of time.

The idea is that scar tissue from surgery causes restriction of growth of the face.  To avoid this problem, we delay the various surgeries as long as possible to let growth proceed more normally.  Research has shown that facial growth may be improved by following this kind of plan.  See “Articles” to the right.

Dr. Warnock uses this basic schedule for surgery:

2 months of age:  Cleft lip repair, cleft nose repair, placement of palate prosthesis.

12 months of age:  Repair soft palate, replace palate prosthesis with a new, bigger one.

4 years of age:  Remove palate prosthesis and repair the hard palate and gumline (alveolus).

6 years of age:  Alveolar bone graft.  This is placement of bone material from the hip into the gumline to allow normal tooth development.

12-13 years of age:  Rhinoplasty (nose repair).

The palate prosthesis is a plastic device that is similar to a retainer.  It is permanently secured with pins that extend into the palate bone.  The palate prosthesis helps to shape the gumline so that teeth can line up more easily.  Once in place, the prosthesis is painless for the child and requires no maintenance or attention from the parent.  Essentially all children with clefts require orthodontic braces.


How are clefts repaired?

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