cleft lip & palate

Cleft lip and cleft palate is a congenital deformity caused by abnormal facial development during gestation. A cleft is a fissure or opening—a gap, typically affecting one or both sides of the lip and/or the hard and soft palate. It occurs as the result of the failure of the different parts of the developing nose, lip and upper jaw to align and fuse properly at an early stage of pregnancy. The following corrective procedures are available:



• Primary Repair - Primary repair, at the age of three months consists of closure of the cleft in the upper lip which simultaneously reconstructs the affected nostril(s). Where appropriate this operation is preceded by orthodontic strapping or a lip adhesion. Primary lip repair is normally accompanied by the closure of the hard palate.
• Soft Palate Repair - Around the age of nine months the gap under the nasal area is bridged by advancing flaps of tissue from either side of the palate and the nasal lining is repaired. Soft palate muscles are joined in the mid-line to prepare for speech. This is performed in conjunction with the insertion of grommets into the eardrums.
• Nasoendoscopy - At around the age of six, if a child experiences difficulties creating certain sounds in speech, this procedure is performed using an flexible endoscope via the nose, to examine the function of the soft palate and pharynx (soft tissue at the back of the mouth) during speech. The purpose of the procedure is to provide a clinical baseline for further management which may include a pharyngoplasty to minimise air escape through the nose.
• Pharyngoplasty - Augmentation/flap pharyngoplasty is appropriate when the pharynx and soft palate are unable to meet to create certain sounds during speech. It is typically used to correct speech problems in children with cleft palate.
• Alveolar Bone Graft - In most cases of cleft lip and palate there is a gap in the alveolar ridge (top jaw bone) which prevents teeth from erupting normally. Following orthodontic treatment, at nine to ten years of age the bony defect is corrected by performing an Alveolar Bone Graft. Bone harvested from the hip is used to repair the defect in the upper jaw, completing the dental arch. This allows the developing teeth to erupt on time so that further orthodontic treatment to align them can proceed.
• Orthognathic Surgery - In early adulthood, when growth is complete, an assessment is made of the final facial form and dental function. If there are discrepancies in upper an lower jaw size, orthognathic surgery may be required. Bones are cut and re-aligned, then held in place with either screws or plates to correct skeletal disharmony resulting in an improved facial appearance.
• Cleft Lip Nose - Upon completion of growth, in some patients a definitive nasal correction may be performed using a costal cartilage graft. This is usually achieved through open rhinoplasty.