Q: What are the pros and cons of cleft lip and palate repair?

Pros Surgery can improve the appearance of a baby’s face and may also improve breathing, hearing, and speech and language development. Surgical results will depend on the severity of the condition. Most babies heal without problems. External incisions are typically placed in the normal contours of the upper lip and nose, so scarring is minimal. Over time, scars will fade. Cons Several surgeries may be involved in repairing the lip (to make it look as normal as possible) and palate (to improve speech). The most common risk of surgery is bleeding, which can be controlled if it occurs.

Question 1

What’s a cleft lip and palate repair?

Accepted Answer

A cleft lip or cleft palate is an opening or split in the upper lip, the roof of the mouth (the palate), or both. They result when a baby’s lip or mouth doesn’t form properly during pregnancy: instead of fusing together, the baby’s face and mouth don’t fuse or fuse only partway, leaving an opening, or cleft.

The opening in the lip can be a small notch or a complete slit that goes all the way to the base of the nose. It can appear on one or both sides of the face or—very rarely—in the middle of the lip. With a cleft palate, only part of the palate may be open or both the front and back parts of the palate can be open. A cleft palate can range in length from a split in the uvula (the fleshy extension at the back of the soft palate that hangs above the throat) to a gap completely through the hard and soft palate. The cleft most often exposes the underside of the nose.

The most common birth defects (together, they’re called “orofacial clefts”), cleft lip and cleft palate occur in about 1 in 700 births. Because the lip and palate develop separately, it’s possible for a child to have a cleft lip, a cleft palate, or—as occurs in about 50% of cases—both a cleft lip and cleft palate.

Though not a fatal problem, clefts can cause problems with speech and hearing, and they’re usually repaired within the first year of a baby’s life. Cleft lips and palates are among the most treatable birth defects: according to the Mayo Clinic, for most babies, a series of surgeries can restore normal function and achieve a normal appearance, with minimal scarring.

Question 2

What are the pros and cons of cleft lip and palate repair?

Accepted Answer

Pros

Surgery can improve the appearance of a baby’s face and may also improve breathing, hearing, and speech and language development. Surgical results will depend on the severity of the condition.
Most babies heal without problems.
External incisions are typically placed in the normal contours of the upper lip and nose, so scarring is minimal. Over time, scars will fade.

Cons

Several surgeries may be involved in repairing the lip (to make it look as normal as possible) and palate (to improve speech).
The most common risk of surgery is bleeding, which can be controlled if it occurs.

Question 3

What happens during cleft lip and palate repair?

Accepted Answer

The surgery takes place in a hospital, under general anesthesia, so the baby won’t be awake or feel any pain. The surgery takes two to three hours, and most babies can go home after one to three days in the hospital, depending on what’s being repaired. Most of the stitches will dissolve on their own and won’t have to be removed later.

Several different surgical techniques are used to repair and reconstruct the lip and palate. The precise surgical plan will vary from patient to patient.

Cleft lip repair

The surgeon will repair a baby’s cleft lip first with a surgery called cheiloplasty, usually when they’re at 4 to 6 months of age. The goals of the surgery are to close the cleft and restore normal anatomy and function of the lip as well as to improve the shape and symmetry of the upper lip and nose.

During the procedure, the plastic surgeon will make incisions on both sides of the cleft, to create flaps of skin, muscle, and oral tissue. It’s rare for tissue to be needed from elsewhere on the body to close a cleft. The flaps are then drawn together and stitched, closing the cleft. If the cleft lip is wide, special techniques may be used to help bring parts of the lip closer together. If needed, the shape of the nose can also be addressed at the same time.

Cleft lip repair usually leaves a small scar under the nose.

Cleft palate repair

Cleft palate repair is usually done when the child is older (between 9 months and 1 year old), to allow the palate to change as the baby grows.

The surgery, called palatoplasty, is performed to close the opening between the nose and the mouth. The repair is done in layers, to create a normal palate. The plastic surgeon will make incisions on either side of the cleft and move tissue on both sides of it, then attach them to each other. This closes the opening to the nose. The muscles of the soft palate (the back of the palate) are rearranged and repaired so they work better during speech. The repair is then stitched closed along the midline of the roof of the mouth.

CLEFT LIP AND PALATE REPAIR

Cleft lip repair

Cleft palate repair

Karyn Repinski

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Karyn Repinski

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