Cleft lip and palate repair surgery is a surgical treatment targeting congenital cleft lip or palate, primarily aimed at correcting the anatomical abnormalities of the oral lip and maxilla. This procedure not only improves appearance but also restores functions such as sucking, speech, and chewing, while reducing the risk of future complications like dental malocclusion or otitis media. Treatment is typically performed by a multidisciplinary team including plastic surgeons, otolaryngologists, and speech therapists to ensure comprehensive efficacy.
Cleft lip and palate have complex causes related to genetic and environmental factors. Treatment plans are individualized based on the patient's age and severity of the condition. Early surgery (within a few months after birth) can enhance language development and psychological adaptation, making it a foundational treatment approach.
There are three main types of surgery: cleft lip repair, cleft palate repair, and secondary revision surgeries. Cleft lip repair involves suturing muscles and tissues to reconstruct the orbicularis oris muscle continuity and restore lip symmetry. Cleft palate repair involves suturing the hard and soft palate tissues to restore the separation between the nasal cavity and oral cavity and improve speech.
Secondary revision surgeries include bone grafting during adolescence and nasal reshaping to address residual issues after initial surgery. The surgical mechanism focuses on precise alignment of tissue layers, using absorbable sutures to minimize scarring, and applying tissue tension principles to ensure functional restoration.
Suitable for initial cases aged 3 to 6 months after birth, and for adolescents requiring secondary repairs after age 5. For patients with concurrent hearing impairment or delayed speech development, surgery should be coordinated with hearing correction and speech therapy.
The surgery is performed under general anesthesia. Cleft lip repair is usually done within 3 months after birth, taking approximately 1.5 to 2 hours. Cleft palate repair is scheduled between 10 and 18 months of age, with a duration of about 3 hours. Techniques include the Millard or Tennison-Randall methods, selected based on the shape of the cleft.
Secondary repairs are tailored according to the patient's age and specific issues; for example, bone grafting is performed after the age of 12 when teeth development is stable. Postoperative care includes orthodontic treatment and speech training, with a long-term follow-up plan.
Long-term follow-up shows that over 85% of patients achieve socially acceptable appearance post-surgery, with speech improvement rates reaching up to 90%. Secondary repairs can further enhance nasal shape and dental arch form, improving quality of life.
Short-term risks include postoperative bleeding, infection, and anesthesia-related complications, with an incidence of about 2-5%. Long-term issues may include scar hypertrophy, abnormal nostril shape, or temporomandibular joint disorders. After palate repair, there may be velopharyngeal insufficiency leading to hypernasal speech.
Serious complications include airway obstruction and significant bleeding, requiring hospitalization for more than 48 hours. Postoperative care involves strict adherence to wound cleaning and feeding instructions, avoiding early contact with the wound tissue.
Contraindications include uncontrolled congenital heart disease, severe anemia (Hb<8g/dL), or active upper respiratory infections. Preoperative assessments should include vaccination and cardiopulmonary evaluation. During the first two weeks post-surgery, behaviors like sucking on pacifiers or other actions that increase tissue tension should be avoided.
Patients with coagulation disorders should undergo hematology evaluation. Diabetic or preterm infants require adjusted anesthesia plans. Follow-up every 3-6 months to monitor dental development and speech progress is recommended.
Orthodontic treatment should be synchronized, with preoperative dental alignment correction starting 3 months prior to surgery to improve precision. Collaboration with speech therapists for articulation training is essential, with speech evaluation beginning 6 months postoperatively. Patients with hearing impairments should undergo ventilation tube placement in coordination with ENT specialists.
If tissue expanders or autologous tissue grafts are used, anesthesia time and hospitalization duration should be adjusted. During secondary repairs, previous surgical effects on tissue conditions should be considered to avoid repeated tissue damage.
International studies show that 90% of patients achieve good appearance after cleft lip repair, and 80% achieve normal velopharyngeal closure after palate repair. Long-term follow-up indicates that patients who undergo comprehensive treatment have no significant differences in psychological adaptation and social integration compared to the general population in adulthood.
The Taiwan Cleft Lip and Palate Association's 20-year follow-up study reports that patients following multidisciplinary treatment plans have a 60% reduction in speech disorders and a 40% decrease in orthodontic needs. Surgical success correlates positively with the surgeon’s expertise.
Non-surgical options include nasal molding devices and orthodontic plates, which can be used preoperatively to adjust nasal shape and alveolar clefts. Speech aids can temporarily improve nasal resonance but cannot replace tissue structure repair.
Extremely premature infants or those with severe cardiopulmonary conditions may need to delay surgery and use feeding aids first. However, studies confirm that patients who do not undergo surgery have up to a 70% rate of appearance and functional impairments in adulthood, making surgery the preferred treatment.
Preoperative assessment includes overall health evaluation, including cardiopulmonary function and nutritional status, to ensure the patient can tolerate anesthesia and surgery. Within 24 hours post-operation, close monitoring of breathing and feeding is necessary, with initial small-volume feeds to avoid stimulating the wound. Parents should learn proper feeding techniques in advance and prepare sterilized special bottles to reduce infection risk.
Will there be obvious scars after surgery? How can their appearance be minimized?The visibility of scars varies among individuals, but surgeons use hidden suturing techniques, designing incisions along natural lip lines to reduce visual traces. Postoperative care includes using anti-scar gels or silicone sheets as instructed and avoiding direct sunlight on the scar. Regular follow-up is necessary to monitor scar changes, and if abnormal healing occurs, secondary revision surgery can be performed in adulthood.
When should speech therapy begin? How should it coordinate with surgical timing?Speech therapy usually starts 6 to 8 weeks after surgery when the wound has stabilized. Therapists will conduct pronunciation training and oral muscle exercises to improve articulation. If secondary bone grafting or maxillary orthognathic surgery is needed, speech therapy may be temporarily paused until skeletal stability is achieved, then resumed. The treatment schedule should be closely coordinated with surgical progress, planned by a multidisciplinary team.
How can postoperative infections be minimized? What daily care precautions should be taken?The infection risk is approximately 1-3%. Postoperative care includes timely application of antibiotics and wound cleaning, avoiding sucking on pacifiers or hard objects that may irritate the wound. For two weeks after surgery, avoid hot or刺激性 foods, and rinse the mouth with saline solution after feeding. Immediate medical attention is necessary if redness, swelling, discharge, or fever occurs.
Is follow-up necessary in adulthood? What are the main items to check?Even after surgery, it is recommended to undergo craniofacial structural assessments every 3-5 years, including dental alignment, nasal symmetry, and airway patency. Adults may develop secondary deformities due to skeletal growth, requiring evaluation with X-rays or 3D imaging for potential orthognathic surgery. Monitoring speech function and psychosocial adaptation is also important to ensure long-term stability of function and appearance.
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