Treatment

Cleft lip repair

Lip repair is carried out at around 3 to 4 months under full anaesthetic. The whole emphasis is on muscle repair in order to mould the distorted premaxilla back into place. The repair involves making incisions and bringing the pieces of lip together to form a full lip. There are a number of different techniques from which the surgeon can choose depending on the nature of the cleft. Your child will be given pain killers after the procedure, and the stitches will be removed after approximately one week, again under general anaesthetic.

Cleft palate repair

Palate repair is carried out between 6 and 12 months of age and likewise is carried out under full anaesthetic. The surgery involves making a number of incisions in the palate and using the tissue and muscle present to close the cleft in three layers, namely the roof of the mouth, the floor of the nose and the muscle in between. Like the lip repair, there are a number of different techniques the surgeon can use. In about 10% of palate repairs the centre of the repair does not heal, leaving a hole (fistula) through which there may be excess leakage. This hole usually needs to be closed surgically at a later stage (between 3 and 10 years of age).

Pharyngeal flap

Pharyngoplasty

This procedure involves repositioning some of the tissue from the palate and the back of the throat so as to prevent air escape through the nose, the escape having resulted in nasal speech.

This escape of excess air is referred to as Velapharyngeal incompetence (VPI). This procedure is required in approximately 10-20% of all palate repairs.

VPI cannot be corrected by speech therapy alone.

Alveolar cleft bone grafting

Alveolar bone grafting is the replacing of missing bone in the front and roof of the mouth. This procedure is carried out when the second, or permanent, teeth are beginning to erupt, which is usually at around 9 to 11 years of age. The orthodontist determines the timing while the procedure is carried out by either a maxillo-facial surgeon or plastic surgeon. The bone graft ensures that teeth have a stable support to erupt through. The bone for the graft is taken from the iliac crest (the top of the hip). See Orthodontics (9-13 years)

A lip revision can sometimes be carried out at the same time as the bone graft if the initial lip repair is deemed to be some way unsatisfactory.

Rhinoplasty

Rhinoplasty, or nasal surgery, is designed to improve the appearance of the nose. It may be carried out because the nose appears either flat or asymmetrical. Ear cartilage is used to build up the flat nose. This surgery is carried out upon the recommendation of the surgeon and can take place anytime from just prior to your child attending school right up into his/her teenage years. Early repair may not prove sufficient as the shape of the nose changes constantly throughout the teenage years requiring further intervention. For this reason you may find the surgeon reluctant to recommend such early nasal surgery. Indeed this surgery is often left until the age of 16-18 years.

Cleft lip and palate surgery services in the EHB region, 1999

In February 1999 a report into the development of oral and maxillofacial surgery services in the Eastern Health Board region was published. The terms of reference included a review of current and anticipated future needs, existing services and resources, identify shortcomings, and indicate any additional resources required.

We include those sections of the report covering cleft lip and palate surgery services in the EHB region.

Situation in Ireland in 1987 – A look back

An article appeared in the Irish Times in October 1987 reviewing the state of treatment in Ireland at that time.
Read the full article.


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