Cleft Lip Repair and Cleft Palate Repair

Cleft Lip/Palate Overview in Utah

  • A malformation of the upper lip or roof of the mouth
  • Affects about every 1/700 babies per year
  • One or both defects may occur
  • Cleft lip may be one sided or affect both sides
  • Cleft palate may be partial or affect the hard and soft palate
  • Cleft children usually have an associated nasal deformity
  • Severity differs from patient to patient
  • There is no one particular cause for the deformity
  • Current techniques allow improved correction of these defects
  • Cleft Team Approach allows for comprehensive care
  • Most of these children are “normal” and grow up to be wonderful members of society

*Disclaimer: Individual results vary. Images do not constitute a promise or representation of any particular outcome or experience.

About Cleft Lip/Palate procedure in Salt Lake City, Utah

A cleft lip is the separation of the upper lip and a cleft palate is the separation of the roof of the mouth. A cleft lip and cleft palate can occur separately or sometimes they can occur together. In some cases a cleft may be formed on both sides of the lip. A cleft occurs early in the development of the fetus, while it is still in the womb. The purpose of a cleft lip/palate operation is to give a child the benefit of a normal functioning mouth and appearance. A cleft lip repair procedure in Salt Lake City with Dr. Fairbanks can improve a child’s ability to breath, eat, speak, and even hear. It should be noted that depending on the severity of the deformity, a child might require a number of operations throughout their lifetime to achieve optimal results. Some clefts are part of an associated syndrome and may require additional care. A child born with a cleft is generally of normal intelligence, and can anticipate a long and healthy life. Cleft Children are Wonderful Children.

*Disclaimer: Individual results vary. Images do not constitute a promise or representation of any particular outcome or experience.

Cleft Lip Repair in Utah

Cleft lip repair has been optimized with the team approach.  The cleft team typically includes the plastic surgeon for the cleft lip and palate reconstruction, an otolaryngologist (ENT) for hearing and airway issues, a speech pathologist for evaluation and speech therapy, a geneticist for evaluation of possible syndromes, and a social worker.  Cleft child is followed closely during the first few years of development to help the cleft child to have the care needed to optimize comprehensive care and the final outcome. Dr. Fairbanks is a member of the Cleft Team at the Primary Children’s Hospital in Salt Lake City, Utah.

*Disclaimer: Individual results vary. Images do not constitute a promise or representation of any particular outcome or experience.

Timeline of Correction of Clefts in Salt Lake City, Utah

Cleft Lip:
  • Ideally the child is seen by a Craniofacial Plastic Surgeon in the nursery or within the first week of birth.
  • If needed, a stent is placed to help form the nose and align the gums by 2 weeks of age.
  • Ideally the first surgery is at 3 months.
  • If the cleft lip is large, a preliminary procedure may be needed at 3 months before the formal lip repair.
  • If the cleft lip is narrow, the formal lip repair is typically done at 3 months.
  • Dr. Fairbanks typically performs a Cleft Rhinoplasty (nasal surgery) at the time of the formal lip repair.

*Disclaimer: Individual results vary. Images do not constitute a promise or representation of any particular outcome or experience.

Cleft Palate:
  • Repair of the palate depends on the extent of the deformity.
  • A very narrow cleft of the gums may be repaired at the time of the lip surgery.
  • Cleft palates are typically treated in stages.
  • Generally, the hard palate is covered with a “button” (prosthesis), at the time of the lip repair, to help the child eat and eventually speak.
  • The soft palate is repaired between 10 and 12 months to prepare the child to talk.
  • The cleft of the alveolus (the gums) is usually repaired at 5-6 years old with bone (Alveolar Bone Graft).
  • The hard palate may be repaired at the same time as the Alveolar Bone Graft.
  • Cleft palate children are followed closely with speech therapy.
  • Additional procedures are available is speech optimization is needed.
Cleft Nasal Deformity:
  • Typically the cleft nasal deformity is addressed at the formal lip correction (Cleft Rhinoplasty).
  • Additional small procedures may be done during adolescence.
  • A formal Rhinoplasty (nasal surgery) is usually done when the patients face is mature, typically at the age of 16.

*Disclaimer: Individual results vary. Images do not constitute a promise or representation of any particular outcome or experience.

Details of the Cleft Lip and Palate Procedures

Cleft Lip Repair in Utah

The goal of our Salt Lake City cleft lip repair surgery is to bring the separated tissue of the upper lip together to allow the child normal function and appearance. If the cleft lip is large, a preliminary procedure may be needed at 3 months before the formal lip repair. This is called a Lip Adhesion. The edges of the cleft are sewn together to help narrow the cleft and the underlying cleft palate. This takes tension off of the skin at the time of the formal lip repair about 3 months later. If the cleft lip is narrow, the formal lip repair is typically done at 3 months. To repair a cleft lip, an incision is made on either side of the cleft; this creates flaps of skin, with the underlying muscle, that can be stitched together to close the cleft. The muscle is sewn together for better lip function. The cleft which neither extends into a nostril or is associated with a cleft palate, may be closed in a single stage.

Typically children with cleft lips end up with an under-projected nose and flaring of the affected nostril. This is why the Cleft Rhinoplasty is done at the time of the formal lip repair, to decrease the extent of these deformities. After skeletal maturity (16 years-old) additional corrections may be done (Formal Rhinoplasty). This may require correction using cartilage grafts. As noted above, the operations on the nose are timed according to age and appropriateness.

Cleft Palate Procedure in Utah

The goal of cleft palate repair at our Salt Lake City clinic is to allow the child the ability to eat and speak normally throughout their life. The Eustachian tubes, canals between the ear and the nasal passage, may be affected with cleft palate children and typically require small silicone tubes placed in the ear drums by an ENT surgeon. This decompresses the ear and helps to decrease ear infections. This procedure may be done at any stage of the cleft lip and/or palate repairs.

Tissue and muscles around the cleft are repositioned during Salt Lake City cleft palate surgery to function as a normal roof to the mouth. Cleft palates are typically treated in stages. Generally, the hard palate is covered with a “button” (prosthesis), at the time of the lip repair. The soft palate is repaired between 10 and 12 months to prepare the child to talk. To repair the soft palate, specialized surgical techniques are utilized to reposition and suture the muscles and tissue to close the defect.

Bilateral cleft lip and palate deformities may be accompanied with a protrusion of the mouth, short nasal tip and wider nostrils. The bilateral cleft is better repaired using similar stages as noted above for the unilateral clefts.

Dr. Grant A. Fairbanks has extensive experience in cleft lip and palate repair; he has successfully treated children with excellent results in both appearance and speech. Each child’s cleft is addressed and the stages will be performed according individual needs.

*Disclaimer: Individual results vary. Images do not constitute a promise or representation of any particular outcome or experience.

Cleft Lip Recovery

The child is kept overnight at the hospital after Salt Lake City cleft palate surgery. Bottle feeding starts the same day of the surgery. Pain medications are provided. Specific instructions are given about proper care of the surgical site and oral medications. Instruction will also be given about any other considerations on health of the child, such as feeding.

Elbow restraints are used to keep the child from putting fingers, spoons and toys in the mouth to help avoid damaging the surgical site as it heals. These restraints may be taken off a few times a day to exercise the joints and for bathing. Pain medications may control discomfort. Typically sutures do not need to be removed since Dr. Fairbanks uses dissolvable sutures. Full healing will take several weeks as the swelling goes down. It is recommended to avoid sunlight exposure for a year to prevent darker scars.

Cleft Palate Recovery

After repair of the Cleft Palate, an overnight stay at the hospital is expected. As with Cleft Lip surgery, bottle feeding starts the same day. The child is provided pain medications. Prior to going home, specific instructions are given about proper post-operative care and medications. Additional instructions will also be given about feeding.

As with Cleft Lip repair, elbow restraints are used to keep the child from putting fingers, spoons and toys in the mouth. This helps avoid damaging the newly repaired palate as it heals. These restraints may be taken off, under strict supervision, a to exercise the joints and for bathing. Sutures do not need to be removed since Dr. Fairbanks uses dissolvable sutures. Healing will take several weeks as the swelling goes down. It is and the scars soften. Speech is evaluated as the child develops.

*Disclaimer: Individual results vary. Images do not constitute a promise or representation of any particular outcome or experience.

What to expect after Cleft Surgery in Utah

Cleft Lip

As the scar of the Cleft Lip matures it will turn from a reddish color to a lighter color which may take one year. The swelling is typically resolved by 3 months. It should be noted that, while great care will be taken to design the scars to be within the normal contours of the face, some scars will always be visible. Typically these scars are acceptable.Over the next few years, secondary operations may be necessary to improve function and/or appearance.  Fat grafting has been found to be helpful in giving the lip more fullness.

Cleft Palate

Dr. Fairbanks repairs the Cleft Palate in stages.  The goal with the staged repairs is to decrease scarring and allow for the upper jaw to grow at the same range as the lower jaw.  The hope is to avoid additional surgery to bring the upper jaw forward.  With the staged approach, the hard palate is originally treated with a Prosthetic button to cover the defect while the child is learning to speak. The soft palate is closed at 10-12 months in anticipation of speech development. The child is closely monitored by Speech Pathologists. Speech therapy can be expected as the cleft child is growing and learning to speak. The cleft palate child is also closely followed by an Orthodontist for evaluation and treatments as the teeth are developing.  The Alveolar Cleft, cleft between the gums, this typically repaired between the ages of 5 and 6.  This is done with a bone graft to complete what is called the dental arch.  This will allow the tooth in the space of the cleft to have a better chance to grow down into proper position.  The cleft of the hard palate can be repaired at the same time.

There is always the chance that the upper jaw may not grow as fast as well lower jaw.  This may require a separate Salt Lake City cleft palate surgery to bring the upper jaw forward (Le Fort I osteotomy).  This will be evaluated during the child’s development and the decisions are made with the parents.

The ultimate goal is to have a palate that functions to improve eating and speech while maintaining a proper airway for breathing. 

Cleft Nasal Deformity

Dr. Fairbanks performs the first cleft rhinoplasty at the time of the formal lip repair.  This decreases the stigmata of the cleft nasal deformity which is often a giveaway for a cleft child.  Additional “touchup” surgeries can be done during childhood if needed.  The formal rhinoplasty, which addresses the internal structures of the nose which will improve breathing, is done after skeletal maturity at age 16 or older.  The goal with the cleft rhinoplasty is to give the child a nose that is not typical of a cleft patient and will allow the nose to a more anatomic and function properly.

Call for an appointment for cleft lip and palate care

To schedule your consultation for Cleft Care in Utah, call Fairbanks Plastic Surgery at (801) 951-8099 today.

*Disclaimer: Individual results vary. Images do not constitute a promise or representation of any particular outcome or experience.

Related Procedures:

Rhinoplasty

Septoplasty 

Nasal Airway Surgery

Lip Augmentation

Fat Grafting

*All post-operative pictures are of real patients of Fairbanks Plastic Surgery. Identifiable images are used with patient permission.