Cleft lips and cleft palates are among the most common birth defects affecting children in North America. They occur very early in development, usually between 6 and 10 weeks of the pregnancy.
A cleft lip and cleft palate can be repaired by surgery, though it is a highly individualized procedure. The aim of a cleft lip or cleft palate surgery is to achieve the best possible functionality (how it works) and aesthetic (how it looks) outcome based on your child’s unique defect.
The surgery is done under general anesthesia, meaning your child will be asleep throughout the entire procedure. Surgery often takes one to two hours, but your child will be in the care of doctors and nurses for two to four hours on average. Read more below on the specifics of each type of surgery.
Cleft lip repair surgery
A child receives cleft lip surgery — also known as a cheiloplasty — when he or she is between 3 and 6 months old. The procedure is done to reconstruct the upper lip to a more normal appearance. This involves closing the connective tissues of the lip. The result is often a small scar between the bottom of the nose and the lip.
If your child has a wide cleft lip or a bilateral cleft lip — a cleft down both nostril lines — additional procedures may be needed to help bring parts of the lip closer together before completing the repair. Procedures include lip adhesion and a molding plate device.
Cleft lip surgery will also create a cupid’s bow, which is the curve at the center of the upper lip. If the cleft lip also affects the shape of the nose, additional considerations may be made, such as achieving symmetry between nostrils, creating adequate distance between the nose and upper lip and between the nostrils and increasing the angle of the nose tip to avoid having a flattened nostril or a downward-pulling nostril.
Cleft palate repair surgery
Cleft palate reconstruction — also known as a palatoplasty — is typically performed when your child is 9 to 12 months old. A plastic surgeon or otolaryngologist — an ear, nose and throat doctor — will connect the muscles of the soft palate and rearrange the surrounding tissue in order to close the cleft.
The goal of a cleft palate surgery is to create a palate that allows for normal speech, but some children will speak with a nasal sound or develop a nasal sound as they age.
The palate creates the floor of the nasal cavity, so the following considerations are included in the surgery:
• Allowing for normal growth, function and speech development
• Position of the palate in relation to the ear canal and hearing abilities
• Tooth and jaw development as your child ages
More surgeries may be needed as your child grows and his or her facial structure changes. These can include pharyngoplasty, a procedure done to improve speech, or an alveolar bone graft, which helps provide stability in the jaw for permanent teeth. A bone graft closes gaps in the jaw or gum line around the front teeth and is typically done when your child is between 6 and 10 years old.
As your child reaches the teen years, he or she will likely want to — and should be — more active in decisions about care. He or she may desire additional cosmetic-based procedures to make scars less noticeable, improve the appearance of the nose and upper lip and improve his or her bite with a corrective jaw procedure.
Along with improving physical appearance, these procedures may also improve speech, breathing and overbites or underbites.