When Should a Cleft Lip and a Cleft Palate Be Repaired?

As two of the most common birth abnormalities in the United States and across the globe, a cleft lip and palate occur when a developing baby’s upper lip and the roof of their mouth don’t form properly in early pregnancy. 

Collectively known as orofacial clefts, these deformities can vary greatly in presentation as well as severity. For the thousands of US babies born with a cleft lip or a cleft palate each year, timely surgical repair is the only way to restore normal oral function and appearance.  

As a member of two orofacial cleft surgical teams that serve families across south and central Florida, board-certified plastic surgeon Christopher Brooks, MD, has extensive experience as an orofacial cleft repair specialist. 

Here’s when Dr. Brooks and his team typically perform these important corrective surgeries.  

Understanding orofacial clefts

The first trimester of pregnancy is the most critical time in fetal development. It’s when the brain and spine develop from the neural tube, when organ systems form, and when the heart starts beating. 

It’s also when a baby’s body structure starts to develop. During this time, the bones and skin of their upper jaw, nose, and mouth normally fuse together to form the upper lip and the roof of the mouth (palate). 

When this area doesn’t come together properly or completely, it can leave a gap or split (cleft) in the upper lip, the palate, or both.

Cleft lip

A cleft lip describes any opening or gap in the upper lip. The opening can be a minor notch, a moderate gap, or a large slit that extends to the base of the nose. It can occur on the left or right side of the upper lip, on both sides (two gaps), or more rarely, in the middle. 

Cleft palate

A cleft palate describes an opening in the roof of the mouth that leaves a hole between the nose and mouth. For some babies, only the back part of the palate (soft palate) is affected; for others, the hole extends all the way to the front of the palate, behind the gums (hard palate). 

A cleft lip and a cleft palate usually occur together. When they occur individually, cleft palates are more common than cleft lips. 

Surgical repair for orofacial clefts

Orofacial clefts don’t just affect your baby’s appearance. They can also affect a child’s ability to feed, grow, and develop normally after birth. Babies born with a cleft lip and palate or a cleft palate alone may also be more prone to ear infections, hearing problems, dental problems, and speech difficulties, depending on the severity of their deformity. 

Timely surgical repair by an experienced team of orofacial cleft specialists can make a world of difference for a baby who’s born with either or both of these anomalies.

Cleft lip repair

When both defects are present, this surgery comes first and usually takes place when a baby is about 3 months old. If the procedure can’t happen at that age for some reason, it should occur as soon as possible after that, and within the first year of life.   

Cleft lip repair (cheiloplasty) is an inpatient surgery done with general anesthesia in a hospital setting. In addition to closing the cleft, the procedure aims to improve the shape and symmetry of the upper lip and nose.

If a cleft lip is particularly wide, the surgical team may use special techniques like lip adhesion or nasal alveolar molding (NAM) to close the gap and improve the contour of the nose before they perform the cleft lip repair. 

Cleft palate repair

Surgery to repair a cleft palate is usually done between 6 and 9 months of age, but it can be done later if necessary. While it’s generally recommended within the first 18 months of life, earlier treatment (before 12 months of age) is best in most cases. 

During cleft palate repair (palatoplasty), a team of plastic surgeons works together to close the cleft in layers and rearrange and repair the muscles of the soft palate. The surgery aims to:

Cleft palate repair is also an inpatient procedure done with general anesthesia. Most babies go home after one or two days in the hospital.

Life after orofacial cleft repair

Many children — especially those born with a severe cleft palate — need additional surgeries as they get older. Subsequent procedures may be done to help further improve a child’s appearance, breathing, hearing, and speech and language development.  

With specialized treatment and proper care, most children with orofacial clefts do very well and lead normal, healthy lives. 

To learn more about cleft lip and palate repair at Brooks Plastic Surgery in Hollywood, Florida, call 954-256-5838 today, or click online to schedule a visit with Dr. Brooks any time.

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