What are cleft lip and palate repair?

Indications and Procedures

Cleft lip is more common in males than in females. Additionally, males tend to have more severe cleft deformities than females. Cleft lip repair is classically performed according to the rule of tens: The infant should be ten weeks old, weigh at least ten pounds, and have a white blood cell count under ten thousand (no infections) and a hemoglobin count of ten grams (not anemic). Today, many surgeons prefer to perform repairs earlier in healthy, full-term newborns ranging in age from one day to fourteen days. Cleft lip repairs typically involve making flaps around the lip area and merging the gaping sides. The muscular layer around the mouth must be sealed into a functional unit, as must the skin.

Cleft palate
is more prevalent in females than males by a 2:1 ratio. A cleft palate may involve only the soft palate, or it may involve both the hard and the soft palates. Suckling can be a greater challenge with a cleft palate than with cleft lip. Moreover, middle-ear disease and infections are a greater problem for an infant with a cleft palate, because the reflux of fluids or solids into the nasal or middle-ear regions can occur. Surgical closure of a cleft palate usually is performed on infants between nine months and one year of age; delays can permanently retard speech and phonation development, while premature closure can stunt facial bone growth and contribute to dentition problems. Typically, if both the hard and the soft palates are open, they will be surgically closed at the same time. Closure of the soft palate occurs in a three-layer manner, while closure of the hard palate is done in a two-layer
approach.

Cleft lip coupled with cleft palate is more common in males and tends to be left-sided more often than right-sided. Combined cleft lip and palate repair follows the same plans as described above, but there is greater concern about the well-being of an infant with the combined deformity.

Bibliography

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Clifford, Edward. The Cleft Palate Experience. Springfield, Ill.: Charles C Thomas, 1987.

"Cleft lip and palate repair." MedlinePlus, June 24, 2013.

Dronamraju, Krishna R. Cleft Lip and Palate. Springfield, Ill.: Charles C Thomas, 1986.

Gruman-Trinker, Carrie T. Your Cleft-Affected Child: The Complete Book of Information, Resources, and Hope. Alameda, Calif.: Hunter House, 2001.

Watson, A. C. H. Management of Cleft Lip and Palate. Philadelphia: Whurr, 2001.

Wynn, Sidney K., and Alfred L. Miller. A Practical Guide to Cleft Lip and Palate Birth Defects. Springfield, Ill.: Charles C Thomas, 1984.

Wyszynski, Diego F. Cleft Lip and Palate: From Origin to Treatment. New York: Oxford University Press, 2002.

"Your child's cleft lip and palate repair." plasticsurgery.org, June 24, 2013.