Cleft Lip Repair

A plastic surgeon will repair the baby’s cleft lip first, usually when the baby is about 3 months old. This is done with a surgery called cheiloplasty. It’s done in the hospital while the baby is under general anesthesia.

The goals of cleft lip repair are to:

• Close the cleft.
• Improve the shape and symmetry of the upper lip and nose.

If the cleft lip is wide, special procedures like lip adhesion or nasal alveolar molding (NAM) might help bring the parts of the lip closer together and improve the shape of the nose before the cleft lip repair. Cleft lip repair usually leaves a small scar under the nose.

Cleft Palate Repair

A cleft palate usually is repaired with surgery called palatoplasty (PAL-eh-tuh-plass-tee) when the baby is 10–12 months old. The goals of palatoplasty are to:

• Close the opening between the nose and mouth.
• Help create a palate that works well for speech.
• Prevent food and liquid from leaking out of the nose.

In palate repair surgery, a plastic surgeon will:

• Close the cleft in layers.
• Rearrange and repair the muscles of the soft palate so they work better during speech.
• Make two incisions (cuts) on each side of the palate behind the gums to ease tension on the palate repair.

This surgery requires general anesthesia and takes about 2–3 hours. Most babies can go home after 1 or 2 days in the hospital. The stitches will dissolve on their own.

Your child will need a liquid diet for a week or two, then will eat soft foods for several more weeks before going back to his or her regular diet. You may be asked to keep your baby in special sleeves (“no-nos”) that prevent the elbows from bending. This is so your baby can’t put any fingers or hard objects into the mouth, which could make the cleft palate repair come open.

Some kids with cleft lip and palate may need other surgeries as they get older. These might include:

Speech surgery: Children can develop speech problems even after the palate has been repaired. At your regular appointments with the cleft team, the speech-language pathologist will carefully listen to your child’s speech to help the surgeon decide if another surgery is needed to improve speech.

Alveolar bone grafting: Doctors might use a small amount of bone from the hip to repair the cleft or notch in the gums and to support the permanent teeth as they come in. This surgery is usually done when kids are 7–9 years old.

Nose surgery: Clefts of the lip also affect how the nose looks, so some kids may benefit from more surgery on the nose. Fixing minor problems, such as the shape of the nostrils, can be done during childhood. More extensive nose surgeries, if needed, are done when the child is finished growing.

Orthognathic surgery: Some children with cleft palate need this surgery to realign the jaws and teeth when they’re older. It’s done when the child is finished growing.