Cleft Palate Treatment

When is the BestTime to Repair a Cleft?
Although there is no consensus onexactly the best time to perform surgery, we generally recommendrepair of the lip between three and six months of age. As will bediscussed later, clefts of the palate are generally closed at approximatelytwelve to fourteen months of age.

What Kind of Treatmentis Needed Prior to Surgery?
Depending on the width of thecleft and the presence or absence of a cleft palate, a short periodof presurgical orthopedics may be recommended. Under the directionof a specially trained orthodontist a custom-made device, somewhatlike a retainer or dentures, is fitted into the baby's mouth. Overthe course of several weeks the device gradually pulls the two edgesof the cleft closer together, a situation which will make it easierfor the surgeon to obtain a good lip repair. The closer the sidesof the cleft are before surgery, the less tension there will beon the surgical repair, and, generally the better the cosmetic result.In addition, if the edges of the cleft upper jaw are close enoughtogether to permit repair, a procedure called "bone grafting" (describedin detail later), may not be needed. In addition, the device mayhave an extension into the nose which helps correct the nasal shape.The retainer also makes feeding easier by sealing off the cleftin the roof of the mouth and reducing the amount of milk or formulathat goes into the nose.

What is Done atthe First Operation?

Fig 2: Before Surgery	After Surgery

If the child has a cleft of the lip (either unilateral or bilateral),the first surgical procedure involves closure of the cleft lip,correction of the wide nostril, elevation of the flattened nasaltip, and frequently closure of the gap in the gum. The proceduretakes approximately three to four hours and requires spending oneor two nights in the hospital after the operation. In the case ofa bilateral cleft lip the reconstruction may require a second procedurebefore the child starts school to complete the nasal reconstructioncalled "lengthening of the columella". (The columella is the skinon the bottom of the nose between the nostrils.)