Surgery for Cleft Lip and Cleft Palate

Treatment of cleft lip and palate requires the expertise of a team of specialists in Otolaryngology, Pediatrics, Oral and Maxillofacial Surgery, Plastic Surgery, Genetics, Dentistry, Speech Pathology, Audiology, Nursing, and Psychology. At the Department of Otolaryngology at Columbia Presbyterian, our cleft team coordinates the care of multiple facets of each child’s condition, providing the highest level of care during what may be several years of treatment. We help parents and children through every stage, including feeding infants with cleft lip or palate, speech evaluations, surgical procedures, speech therapy and beyond.

Cleft lip surgery may be performed when a baby is two to three months old. To repair a cleft lip, the surgeon will make an incision on one side of the cleft from the mouth into the nostril. The dark pink outer portion of the cleft will be turned down, and the muscle and the skin of the lip will be pulled together to close the separation. This procedure restores muscular function and the normal shape of the mouth. If the child has defects in the nose due to the cleft, these may also be repaired at the time of lip surgery. Extensive nasal involvement may require a second procedure, however.

Surgery for cleft palate is usually performed when the child is about 12 months old, before learning to talk. In general, the surgeon will make an incision on both sides of the separation and move tissue from each side of the cleft to the center or midline of the roof of the mouth. This procedure rebuilds the palate, joining muscle together and providing enough length in the palate so the child can eat and learn to speak properly. While cleft palate surgery involves only a small part of the mouth in some children, in others it involves a larger area from the front to the back of the mouth. In any case this surgery is usually more extensive than cleft lip surgery.

Clefts involving the gum line may require an operation to place extra bone in the gum, called an alveolar bone graft. This facilitates proper growth of the permanent teeth. Depending on how fast they are developing, alveolar bone grafts may be done between the ages of 6 and 10 years. If the jaws are poorly aligned, surgery can also be performed to align the bite.

Outcomes after cleft surgery

Appearance: After cleft lip surgery, appearance of the face is symmetrical and "normal" although a thin scar remains. While scars may appear enlarged and reddened immediately after surgery, they fade and become less noticeable with time. In some cases, the shadow of the nose and mouth make the scars barely noticeable at all. In other children, the scars may remain more prominent, and touch-up operations may be desired later to improve their appearance.

Speech: Surgery usually significantly improves a child’s ability to pronounce the p, b, and m sounds, although speech therapy is still usually necessary. In about 20% of cases a second surgery may be warranted later to further improve articulation. Unfortunately, it is not possible to predict the need for future surgery at the time of initial palate surgery.

Feeding: A child gains normal eating and drinking ability after recovery from surgery.

Recovering from Surgery

After surgery for cleft lip or palate, it is important to prevent infection and trauma to the surgical site. If there is gauze packing in your child’s mouth, it should be left until directed by your physician.

Following surgery, your child may be irritable and will require pain medication. Non-aspirin or prescription pain medication may be prescribed. Babies may need to wear padded elbow restraints to prevent rubbing and pulling at stitches above the lip. For a day or two, your child will receive fluids through an intravenous catheter in lieu of drinking or eating. Your physician may also prescribe antibiotics to prevent infection immediately after surgery.

Stitches will either dissolve or be removed in about a week after surgery. It is normal to have swelling, bruising and blood around these stitches. After cleft palate surgery, there may be bloody drainage coming from the nose and mouth. This should diminish after a day. Swelling should decrease significantly in a week. Your child may also have nasal congestion, mouth breathing, and diminished appetite.

You will be given specific instructions as to how to properly feed your child; it is important that the sutures are not damaged. While a liquid diet is required (about a week), you may need to feed your child with a syringe with a rubber tip. When your child can eat soft foods, caution must be taken not to damage the suture with spoons or forks. It will be necessary to clean your child’s mouth after meals in order to reduce the chances of infection.

During the week or two after surgery your child can walk or play calmly, but should not run or play roughly or put toys in her mouth.

Useful Links:

For information about the development of cleft lip and cleft palate, see Cleft Lip and Cleft Palate

This article describes surgery for cleft lip and palate, and includes helpful diagrams. American Society of Plastic Surgeons, http://www.plasticsurgery.org/surgery/cleftlp.htm

Thorough information on causes, treatments, and research on cleft lip and palate, in English and en Español, may be found at the website of the National Library of Medicine/ National Institutes of Health, Medline Plus - http://www.nlm.nih.gov/medlineplus/cleftlipandpalate.html