Cleft lip and/or cleft palate are one of the most common congenital deformities seen in the children. These children require the care of a number of specialists to normalize their appearance and function. The first concern is the infant’s ability to feed. (Read more about feeding). The University of Texas Cleft and Craniofacial Team uses the services of a speech therapist and if necessary, a pediatric dentist to ensure the ability to eat. The speech therapist instructs the parents in the use of various nipples. If the child is unable to feed with a nipple, it may be possible to have an obturator made by the pediatric dentist to seal off the child’s cleft palate and improve the sucking.  Once the child is able to eat, the next step is to prepare the infant for lip surgery.

Our Team recommends pre-surgical taping and molding to improve the outcome of the initial surgery.  If your child is a candidate for pre-surgical nasal alveolar molding (PNAM), the pediatric dentist will take a dental impression and fashion an obturator with one or two nasal prongs to help reshape the lip, nose, and palate.  Once pre-nasal alveolar is completed, the child is ready for surgery. (Read more about Pre-surgical nasal Alveolar Molding.)

Cleft Lip Repair is usually done at about 3-6 months of age depending on the type of cleft and the pre-surgical treatment selected. The surgery usually takes 2-3 hours.  The child will be fed immediately following surgery and discharged home the same day. The next step in the treatment of the children with cleft lip and palate is to repair the palate.

Alveolar bone grafting is sometimes required to repair the gap in the gum. Alveolar Bone Graft Surgery is scheduled at 7-12 years of age depending on the child’s tooth eruption.  Care of the child at this stage is usually coordinated between an orthodontist and an oral surgeon. Frequently pre-surgical orthodontic work is necessary prior to bone grafting. The bone for bone grafting is usually taken from child’s hip and used to fill the opening in the gum. The children usually stay in the hospital for one night after the surgery.

The final surgery for children with cleft lip and palate involves the nose and midface. These final steps are delayed until the child has completed his or her growth (approximately age 14-16 for girls and 16-18 for boys). Orthagnathic surgery corrects deformities of the jaw. This surgery may be necessary to obtain better alignment of the jaws and teeth or midface symmetry. This is also the time that desired revision of the nose or lip can be done. The preparation for surgery at the midface often involves many months of orthodontic treatment to obtain the best positioning of the teeth. If the orthodontia work cannot correct the misalignment of the jaw, a surgical procedure (Le Fort I) or a newer procedure Distraction Osteogenesis may correct the jaw alignment. Nasal surgery may be eliminated or minimized if the child underwent pre-surgical nasal alveolar Molding. Nasal surgery is usually done after the bone surgery of the midface.

 

Examples of Unilateral and Bilateral Cleft Lip
Normal roof of mouth	One-sided cleft lip	Two-sided cleft lip

 Cleft Lip and Palate