What is cleft lip and cleft palate repair surgery?

Cleft lip and cleft palate are among the most common birth anomalies affecting children in North America and worldwide. 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 mouth. Surgery is required to repair cleft lip and/or cleft palate.

What causes a cleft lip and/or cleft palate?

A cleft, or separation of the upper lip and/or the roof of the mouth, occurs very early in the development of your unborn child. During fetal development, certain components of the upper lip and roof of the mouth fail to grow together normally. In some cases, a syndrome may be responsible for the occurrence of the cleft. For most affected children, however, the cause will no be known. In these cases, the cleft is thought to result from a complex interaction of genetic and environmental factors.

Cleft lip repair and cleft palate repair are types of surgery used to correct this abnormal development and are meant to restore function to the lips and mouth along with producing a more normal appearance. Most clefts can be repaired through specialized plastic surgery techniques and will help to improve your child's ability to eat, speak, hear and breathe.

A team of specialists can help

Early intervention by a team of specialists is needed to evaluate and manage your child's treatment and development in cases of cleft lip and/or cleft palate. The team will work together to define a course of treatment, including feeding recommendations, surgical repair of the cleft, speech rehabilitation and dental restoration. These specialists may include a:

• Plastic surgeon
• Pediatrician
• Pediatric dentist
• Orthodontist
• Otolaryngologist (ear, nose and throat specialist)
• Lactation Specialist
• Occupational therapist
• Auditory or hearing specialist
• Speech-language pathologist
• Genetic counselor
• Psychologist
• Social worker

It is important to know that at the earliest stages feeding, growth, and development will be the most important priorities for your child's cleft-related care. Specialized bottles, or more rarely, feeding tubes, may be necessary to help your child eat well. Often, when a cleft palate is involved, the infant will not be able to feed at the breast like other infants due to problems with creating oral suction.

More than a cosmetic repair

Surgery to repair a cleft of the lip or palate is highly individualized. Surgery is intended to close the cleft defect, but also to help your child ability to function and grow normally. Cleft lip repair, also called cheiloplasty, includes reconstruction of the lip to create a more normal appearance, namely:

• Closure of the cleft resulting in a scar located within or near the typical features of the upper lip
• Formation of a cupid's bow (the curves along the center of the upper lip)
• Establishing adequate distance between the upper lip and nose

Clefts of the upper lip typically affect the shape of the nose and additional procedures may be recommended to:

• Restore nasal symmetry and nostril shape
• Straighten and create adequate length for the columella (the tissue that separates the nostrils)

Because the palate creates the floor of the nasal cavity and is responsible for allowing normal speech, considerations in repairing a cleft palate include:

• Separating the mouth and nasal tissues by closing the defect along its length
• Re-establishing soft palate muscle function to promote normal speech
• Recreating normal relation of the soft palate to the auditory canal and Eustachian tube to allow for normal hearing
• Promoting as much as possible the normal growth and development of the upper jaw and teeth
• Repairing, when appropriate, any defects in the gumline to allow for permanent tooth eruption

When should my child have the surgery?

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

• Cleft lip repairs are typically performed between 2 and 6 months of age depending on your child's health status and local cleft team protocols.
• Cleft palate repairs are generally performed after cleft lip repair in a separate surgery when the child is between 9 to 18 months of age depending on health status and local cleft team protocols.
• Cleft lip and/or palate repair may be delayed in order to treat other, more life-threatening problems that may be present such as a heart or lung disorder.
• Depending on the severity of the cleft, pre-operative interventions such as cleft lip taping, orthodontic molding (called NasoAlveolar Molding – NAM), or staged surgery techniques may be recommended.
• Other cleft-related surgeries may be needed over time including ear tubes to treat fluid buildup, bone grafting to repair the gumline, and dental or jaw surgery to improve bite relationships