Cleft Lip and Palate Surgery Procedure

Cleft lip and cleft palate are common congenital conditions that occur when a baby’s lip or the roof of the mouth does not form properly during pregnancy. Though the cause is often unknown, these birth defects can be corrected with surgery, offering the child the chance to eat, speak, and grow more normally.

For parents of children born with clefts, one of the most pressing questions is, “What does the surgical process involve?” Understanding the cleft lip and palate surgery procedure—from preparation through recovery—can help reduce anxiety and provide clarity during what is often an emotional journey.

Understanding the Basics: What Are Cleft Lip and Cleft Palate?

A cleft lip occurs when the tissue that forms the lip does not fuse completely, creating a visible gap. It can range from a small notch in the lip to a wide separation that extends into the nose.

A cleft palate involves a gap in the roof of the mouth, which can affect the hard palate (the bony front part) or the soft palate (the back part). These conditions may occur separately or together.

Cleft lip and palate can cause problems with:

• Feeding (especially in infancy)
  
• Speech development
  
• Hearing (due to middle ear infections)
  
• Dental growth
  
• Self-esteem and appearance
  

Fortunately, modern surgical techniques provide excellent outcomes when performed early and followed by appropriate rehabilitation.

When Is Surgery Performed?

The timing of cleft surgery depends on the child’s age, overall health, the type of cleft, and other individual factors.

Cleft Lip Surgery

• Typically performed between 3 to 6 months of age
  
• Earlier repair is encouraged to support feeding and appearance
  

Cleft Palate Surgery

• Generally done between 9 to 18 months of age
• Important for proper speech development and to reduce the risk of nasal regurgitation
  

In some cases, additional surgeries may be needed later in childhood to address speech issues, dental abnormalities, or cosmetic refinement.

Cleft Lip and Palate Surgery Procedure

Prior to the surgery, your child will undergo a thorough preoperative evaluation. This typically includes:

• A physical examination
  
• Review of medical history
  
• Blood tests
  
• Anesthesia assessment
  

Your cleft team may also include a pediatrician, speech therapist, audiologist, orthodontist, and psychologist. You’ll receive detailed preoperative instructions, which may include:

• Fasting guidelines before anesthesia
  
• Stopping certain medications if necessary
  
• Recommendations on feeding prior to surgery
  

Parents are encouraged to ask questions and clarify all doubts with the surgical team before the procedure.

The Cleft Lip Repair Procedure

Cleft lip repair is performed under general anesthesia, which means the child will be asleep and pain-free during the surgery. The procedure typically takes 1 to 2 hours, depending on the complexity and whether the cleft is unilateral (one side) or bilateral (both sides).

Surgical Steps:

1. Marking the Incision
   The surgeon marks the edges of the cleft and plans the incision pattern. This step ensures that the resulting scar will blend with the natural contours of the face.
   
2. Tissue Repositioning and Muscle Repair
   The surgeon makes precise cuts and repositions tissues from either side of the cleft to close the gap. Muscles in the upper lip are also reconnected to restore normal function and symmetry.
   
3. Nasal Correction (if needed)
   If the cleft affects the nose, reshaping the nostril and nasal base may be part of the procedure.
   
4. Stitching and Dressing
   The incisions are closed using fine, dissolvable or removable sutures. A dressing is applied to protect the wound.
   

The aim is to create a natural-looking, functional lip with minimal scarring.

The Cleft Palate Repair Procedure

Palate repair, also called palatoplasty, is more complex and typically takes 2 to 3 hours under general anesthesia. The goal is to close the gap in the roof of the mouth and restore the muscular structure to support speech and feeding.

Surgical Steps:

1. Accessing the Palate Tissues
   The surgeon makes incisions along the sides of the cleft and lifts the mucosal tissue to expose the underlying muscles.
   
2. Muscle Reconstruction
   The soft palate muscles (particularly the levator veli palatini) are reoriented and stitched together to form a functional palate. This is essential for normal speech and swallowing.
   
3. Closing the Mucosal Layers
   After the muscular repair, the mucosal lining of the palate is sutured to fully close the gap. If the hard palate is also involved, additional tissue flaps or grafts may be used.
   
4. Postoperative Packing
   Sometimes absorbable materials are placed to support healing and reduce bleeding.
   

The palate repair allows the child to eat and speak more normally and prevents food or liquids from entering the nasal cavity.

What to Expect After Surgery

Hospital Stay

Most children stay in the hospital for 1 to 2 days after surgery. They are monitored for pain, breathing, and healing. Parents are taught how to care for the surgical site and manage feeding at home.

Feeding

Feeding is one of the most delicate aspects post-surgery. Depending on the procedure:

• For lip repair: Feeding may resume within a few hours using a bottle or spoon.

• For palate repair: Special cups, syringes, or soft-tipped feeding devices may be needed. Sucking on pacifiers or bottles may be discouraged initially.
  

Pain Management

Pain is usually managed with medications such as acetaminophen or ibuprofen. In some cases, stronger medications may be prescribed for a few days.

Wound Care

Parents must ensure the wound remains clean and dry. Antibiotic ointments may be applied to prevent infection.

Children may be fitted with arm restraints (soft sleeves) to prevent them from touching the face or putting fingers in the mouth during healing.

Follow-Up and Recovery

Follow-up visits are scheduled to monitor healing, remove sutures (if non-dissolvable), and assess progress. Most children recover well in 1 to 2 weeks, but full healing may take several months.

Speech development is monitored over time. Some children may need speech therapy or additional surgeries (such as pharyngoplasty or revision procedures) later in childhood.

Potential Complications

Though cleft surgery is generally safe and successful, complications may occur, such as:

• Infection
  
• Bleeding
  
• Poor wound healing or scarring
  
• Palatal fistula (hole in the palate post-surgery)
  
• Nasal asymmetry (after lip repair)
  
• Persistent speech or feeding issues
  

Most complications can be corrected with follow-up care or additional minor procedures.

Long-Term Care and Additional Surgeries

Cleft lip and palate treatment is rarely a one-time procedure. Children are typically followed until adolescence or early adulthood and may require:

• Speech surgeries to improve articulation
  
• Bone grafting at age 7–9 to support tooth eruption
  
• Orthodontic treatment
• Rhinoplasty or lip revisions in teenage years
  
• Psychosocial support during school years
  

The goal is to ensure that the child achieves normal development, both physically and emotionally.

Conclusion

Cleft lip and palate surgery is a transformative procedure that restores not just physical function but emotional and social confidence. The surgical process, though intricate, is well-established and continually improving. Most children go on to lead healthy, active lives with normal speech, feeding, and appearance.

For families preparing for this journey, understanding the procedure and having support from a skilled multidisciplinary cleft team makes all the difference. Open communication with your child’s surgeons, therapists, and care providers will ensure the best possible outcome.