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Presurgical Orthopedics for Babies with Cleft Lip & Palate

A cleft lip or palate can be successfully corrected with surgery and presurgical orthopedic treatment. The cleft palate team’s plastic surgeon and orthodontist work with the child's parents to choose the best timing for surgery. In most cases,  a baby’s cleft lip should be repaired by 3 months of age, while the cleft in the palate is often repaired between the ages of  9 to 12 months. Any surgical procedure is dependent upon a child's general health and the nature of the cleft lip or cleft palate.

Unilateral Cleft

Bilateral Cleft

BEFORE

AFTER

BEFORE

AFTER

Care Before Surgery

Prior to undergoing surgery, a baby will wear a small acrylic plate and lip tape. This is also known as “Presurgical Orthopedics” and is designed to prepare the baby for the best surgical result. Presurgical orthopedics narrows the gap between the lips and gums, improves the symmetry of the nose and minimizes the size of the lip scar from the surgery. In addition, the plate keeps the tongue out of the gap in the roof of the mouth (palate), and allows the gap in the palate to narrow naturally minimizing future palate surgery.

For babies with “bilateral cleft” that is, a gap on both sides of the lip, presurgical orthopedics also brings back the small central portion of the lip and gum in a controlled fashion. This greatly simplifies the surgical repair of the lips and gums, as well as,  reduces the occurrence of postsurgical “fistulae” or small holes after surgery.

The cleft condition leads to obvious problems with the soft tissues of a baby’s face and palate. Less obvious is the effect on the bones that house a baby’s teeth, formation of the palate, as well as the effect on the cartilages that shape and support a baby’s nose.

During the first 3 months of a baby’s life, the levels of estrogen (a hormone) is relatively high in a baby’s blood stream. High levels of estrogen allow cartilage in the nose, which is usually resistant to being reshaped, to be quite mouldable. Once a baby is past this stage, the cartilage is set in an asymmetric shape that is difficult to correct surgically. However, if the cartilage forming the nose is reshapen within the mouldable period, a more esthetic shape may be established. 

Care After Surgery

Children with clefts usually continue to receive treatment after surgery, including extensive orthodontic care, speech therapy, plastic surgery,  jaw surgery, and prosthetic dental reconstruction.