Cleft Lip and Palate Repair

About Cleft Lip and Palate Repair

Cleft lip and palate repair corrects one of the most common birth differences affecting the face, occurring in roughly 1 in 700 births worldwide according to commonly cited estimates, with variation between populations. A cleft lip is a gap in the upper lip, a cleft palate is an opening in the roof of the mouth, and the two may occur separately or together. Cleft lip repair, or cheiloplasty, is usually performed in early infancy. The rotation advancement technique described by the American surgeon Ralph Millard in the 1950s remains widely used for unilateral clefts, rotating tissue downward on one side and advancing a flap from the other to recreate a natural lip with a balanced Cupid bow and to reconstruct the orbicularis oris muscle; specific techniques such as the Mulliken repair are used for bilateral clefts. The nose is often reshaped at the same time in a primary rhinoplasty, and some centers use nasoalveolar molding before surgery to reduce the gap. Cleft palate repair, or palatoplasty, is usually performed later in infancy, before speech develops, and closes the palate and repositions the soft palate muscles to allow normal speech; common methods include the two flap palatoplasty and the Furlow double opposing Z plasty. Later procedures may include bone grafting of the gum line during childhood to support the developing teeth, surgery for velopharyngeal insufficiency, which causes hypernasal speech, revision of the lip or nose, and jaw surgery in adolescence for underdevelopment of the upper jaw. Care is provided by multidisciplinary cleft teams including surgeons, orthodontists, speech and language therapists, audiologists, ear nose and throat specialists and psychologists, as middle ear problems and hearing loss are common. A fistula, a persistent hole in the palate, is a recognized complication.