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Rady Children's Specialists

Cleft Lip Surgery and Palate Plastic Surgery

What is a Cleft Lip?

A cleft lip is a birth defect that may be unilateral or bilateral, complete or incomplete. The goals of cleft lip repair include re-establishment of muscle continuity and re-creation of the normal landmarks of a lip. The skin, muscles, and mucous membranes are surgically moved from their abnormal positions and joined back together again. Cleft lip repair is normally performed around 3 months of age.

Normal landmarks recreated in the repair of a cleft lip include the philtrum or central dimple of the upper lip, the philtrum column or ridge on either side of the central dimple, the cupid’s bow curvature between the white and red regions of the lip, and the vermilion tubercle or pout of the central red part of the upper lip.

What is a Cleft Palate?

A cleft palate may be unilateral or bilateral, involve the soft palate only, soft and hard palate, and extend through the gum where teeth will eventually erupt. The goals of cleft palate repair include re-establishment of muscle continuity in the soft palate and re-approximation of the palate lining across the cleft. The palate lining is shifted from the sides to the center and stitched together. The bare areas left on the sides heal spontaneously.

Cleft palate repair is normally performed around age 6 to 9 months, in time for speech development. When present, a cleft through the gum, or alveolar process, may also be closed at this time; however, a bone graft may be required around age 6 to 8 years to anchor the eruption of a permanent tooth.

Many children will require speech therapy and, occasionally, a surgical pharyngoplasty, to correct nasal speech. The timing of these surgeries for tooth eruption and speech is coordinated by the Cleft Palate Team.

Children with cleft palates may have problems with hearing, speech, and teeth eruption. Cleft palate team members, in addition to plastic surgeons, include audiologists, ear specialists, speech pathologists and therapists, dentists, orthodontists, and oral surgeons.

Treatment of the birth defects cleft lip and palate at Rady Children’s Hospital involves repair of a gap in the upper lip and/or the roof of the mouth, due to lack of fusion. The skill and experience of the pediatric plastic surgeon are critical to maximizing aesthetic and functional outcomes, while also minimizing pediatric plastic surgery, hospital stay, and long-term costs for cleft palate and cleft lip surgery.

Approximately one in 700 children are born with a cleft lip and/or cleft palate. This birth defect may be associated with several difficulties in feeding and nutrition, dentition, facial growth, speech, and sleep or breathing. Kids who might have these birth defects should see healthcare professionals who specialize in palate treatment for the best patient care available.

Reconstructive surgery of cleft palate and cleft lip repair at Rady Children’s Hospital is carried out over a series of years to be timed with the patient’s facial growth. Craniofacial team care from health professionals is mandatory to achieve the best outcomes to help with repairing the birth defects and will ensure proper sequencing of the various surgery procedures listed below.

What is a Cleft Maxillary?

Cleft maxillary hypoplasia is an undergrowth of the maxilla, or upper jaw, that occasionally occurs in children with cleft lip and palate. Cleft Maxillary is more common with a bilateral cleft lip.

As the child’s face grows, the upper jaw is unable to keep up with normal growth of the lower jaw, and the upper teeth become abnormally positioned behind the lower jaw teeth. Using principles of orthognathic surgery, the maxilla can be predictably brought forward, not only normalizing the relationship of the jaws but also normalizing the relationships of the lips to each other and to the nose.

Surgical repair to correct cleft maxillary hypoplasia is normally performed in the teen years after jaw growth is completed. When severe, the deformity is treated earlier to avoid psychosocial harm. The craniofacial surgeons, working together with oral surgeons, have extensive experience with the newer techniques of distraction which are occasionally indicated in the correction of cleft maxillary hypoplasia.

Before surgical repositioning of the upper jaw, the teeth must be prepared for proper alignment and occlusion. Planning and treatment by an orthodontist is required before and after orthognathic surgery of the maxilla.

What is a Cleft Nasal Deformity?

A cleft nasal deformity is typically associated with cleft lip and palate. The affected side of the nose is widened and flattened due to displacement of the nasal cartilage. The goals of cleft nasal surgery are to re-establish normal nasal tip projection and align the nares and position of the nasal base. To supplement the cartilage of the nasal tip, a cartilage graft may be required. Our surgeons are very experienced with nasal surgery and use the latest in techniques and technologies.

Cleft nasal surgery is usually performed at ages 4 to 5 years, before starting school. Because growth may not take place in a normal fashion, revisions of the nasal surgery may be required in the adolescent and teen years.

Children with cleft nasal deformity typically have difficulty nasal breathing due to the deviation of the nasal septum. This can be readily corrected at the time of the cleft nasal surgery.