Ideally, patients should be managed by a multidisciplinary team which includes: Plastic surgeons, maxillofacial surgeons; ENT, speech and language therapists, dentists, orthodontists, psychologists and specialist nurses. They will provide support and treatment until the child stops growing at around 18 years old.
For some children with a unilateral cleft lip, the first operation they need is a lip-nasal adhesion. This operation is performed at about 3 months of age, and involves:
An incomplete cleft lip, either unilateral or bilateral, is usually repaired with one operation when the child is between 3 and 5 months of age. During this operation, the baby’s nasal asymmetry (unevenness in the shape of the nose) is also corrected.
During the repair procedure, a plastic surgeon uses the existing muscle and tissues of the child’s lip and nose to close the cleft. Repair of a unilateral cleft lip is typically performed in the operating room under general anesthesia. The child will stay in the hospital for one to two nights after the operation.
A child with a complete cleft lip typically needs two operations. The second operation is a more comprehensive repair of the cleft lip and correction of the nose. This procedure usually takes place at 5 to 6 months of age.
After the operation, the child’s lip, nose and face will be swollen for a few days. His scar may be red for several weeks. It will take 6 to 12 months for the scar to soften and fade. Although it will never completely disappear, in time, the scar will become difficult to see. The child’s lip and nose will be nearly normal in appearance after the swelling and scar have subsided.
Although some children need to have another procedure on their lips and/or nose before they begin school, or as they enter adolescence, other children never need further surgeries.
Children whose cleft lips involve the alveolus, or gum line, typically need another operation to help their permanent teeth come in and to make it easier for orthodontic treatments to improve their bite and jaw function. This operation is called an alveolar bone graft, and is usually performed when the child is 8 to 10 years old.
A plastic surgeon brings together the separated muscles and tissue from the two halves of the palate to close the opening. This procedure is performed in the operating room under general anesthesia. The child will be in the hospital anywhere from one to three nights after the operation.
A cleft palate is typically closed between the ages of 8 and 11 months, before a baby makes his first attempt to speak. The plastic surgeon will discuss the best repair plan for his needs and circumstances.
The child should be given soft foods, using the side of a soft-tipped baby spoon. After each feeding, be sure to rinse the child’s mouth with water. Rinsing is very important, especially for the first 10 to 14 days after surgery. The child may regurgitate some food and liquid through his nose for up to three months after the operation. This is normal. It takes time for the swelling to diminish and for the muscles in the palate to begin working properly.
Approximately 5 to 15 percent of all children who have undergone a cleft palate repair will need a second operation to correct “nasal”-sounding speech. The most common procedure used to fix this problem is called a pharyngeal flap, which is performed when the child is about 5 years old.