Cleft lip and palate surgery

Cleft lip and palate is a congenital abnormality that is not uncommon. It is a easily treated condition requiring contributions from multiple specialists. The deformity results in both aesthetic and functional deficits. The deformity may vary from a very minor clefting phenomenon to wide clefting involving bones of the middle of the face and soft tissues of the lip, nose and the palate.

The treatment can potentially begin in the first week of life. Moulding of the bone and affected soft tissues is useful for repositioning of malpositioned structures with the use orthodontic appliances. This will improve the results of surgery. The cleft lip and nose is repaired at 3 months of age and the cleft palate is repaired at 9 to 12 months of age. The aim of the surgery is to separate the oral from the nasal cavity and restore functional anatomy for development of speech. Despite a good repair work about 10% of patients will develop nasal speech. Speech therapy if instituted earlier is able to correct the speech pattern in a significant number of children. Any child that has not responded will require additional surgery. This surgery is usually effected at a age of 3 to 5 years of age. Revisional surgery to the lip and the tip of the nose can also be performed in this period. Speech therapy is usually continued after the surgery to correct acquired compensatory speech manners.

Next phase of treatment usually begins at the age of 8. The cycle of deciduous teeth replacement by permanent ones is established. In patients in whom the gum is also clefted, the eruption of the canine through the cleft need to be controlled. The dental arch of both jaws bearing the teeth needs to be managed orthodontically to align the arch and the dentition. Usually by the age of 14 years orthodontic management is complete.

At the age of 12 to 14 year bone grafting surgery is performed. The aim is to bring about union of the 2 segments of the upper dental arch thereby maintaining the alignment of the jaw and the dentition after the removal of the orthodontic dental hardware.

A significant number of patients reaching adulthood have retruded midface. This is mainly as result of the under development of the upper jaw associated with a clefting deformity. Jaw surgery performed by a maxillofacial surgeon can correct the deformity. The surgery has to be tailor made to suit the patients underlying jaw position relative to each other.

Lastly the patient usually at an age of 18 to 21 years rhinoplasty is performed to finally harmonise the face.

Surgeries and other therapeutic interventions performed timeously have the potential to restore the face to near normality. In the absence of appropriate care an unfortunate few have to live with the stigma associated with a cleft lip and palate.