Surgery For Cleft Lips And Palates


What Are Clefts?

An orofacial cleft is one of the most common abnormalities to be seen in newborns. The condition is marked by an opening in the roof of the mouth and/or lip due to tissues failing to join together properly while the baby developed in the womb. Plastic surgery can correct this early-life defect, and most children can have surgery for both cleft lip and cleft palate within the first or second year of life. When it comes to such plastic surgery, Portland's Dr. Kathleen Waldorf at The Waldorf Center for Plastic Surgery is particularly committed to addressing the problem around the world, working with the nonprofit Faces of Hope to help children avoid cleft-associated problems—such as speech delays, inadequate nutrition intake, and more—by performing repairs. She has found that there are many people who do not understand how clefts develop or what can be done to close them. 

Cleft Formation 

During the first six to 10 weeks of a typical pregnancy cycle, the bones and tissues of a baby's upper jaw, mouth, and nose fuse together to form the mouth's "roof" and the upper lip. A cleft occurs when portions of the lip and mouth do not come together as they should. 

Clefts can take many forms. They can appear as a small opening on the very edge of the lip or extend all the way into the nose and gums. The sizes of palates also vary. The soft palate located near the back of the throat can be affected, or the hard palate situated near the front of the mouth can feature an opening.  

There are three categories of clefts: a cleft lip, a cleft palate, and a combined cleft lip and palate. Furthermore, the defect can appear as a unilateral cleft (on one side of the mouth) or as a bilateral cleft (on both sides of the mouth). Doctors can usually discover a cleft lip when the baby is born or even through a prenatal ultrasound. That said, cleft palates are most easily detected after a doctor carefully examines the inside of the baby's mouth after birth.  

What Causes Clefts? 

There are several elements that may contribute to the formation of clefts, including a genetic component and environmental factors such as medications or a lack of vitamins. Women who take certain drugs during pregnancy can increase their chance of having a baby with a cleft palate or lip. Similarly, mothers who are not getting the required amount of prenatal nutrients (e.g. a lack of folic acid) may increase the risk of their baby forming a cleft. Pregnant women who drink alcohol, use drugs, or smoke cigarettes can also increase the risk of congenital disabilities. 

Surgical Cleft Repair  

The goal of surgical cleft repair is to restore the typical appearance and function of the upper lip and palate. The necessary plastic surgery can be performed on a patient of virtually any age, but the operation is recommended for babies between the ages of two to six months. In most scenarios, the surgeon will rearrange the tissue in the area around the cleft to close the opening. A critical part if this surgery is the detachment and repositioning of the lip muscle to reconstruct the circular tissue around the mouth. The number of steps and procedures required to repair a cleft lip or palate will depend on the position, width, and depth of the cleft. During surgery, the surgeon may provide additional support for the nose. Nose reconstruction is typically completed at the same time as the cleft lip surgery.  

Cleft Lip and Palate Recovery 

After a baby receives plastic surgery to close a cleft, several days of dietary restrictions are recommended. Bottles, pacifiers, straws, and similar items that require sucking should be avoided for some time after surgery. Arm restraints may be provided to prevent children from touching their nose or mouth area as it heals. Pain medication can be used to manage discomfort. 

Ultimately, sutures may require removal depending on the surgical technique used. Healing can take weeks, during which any external scars will be visible, but will fade to become less noticeable over time. Cleft lip and palate surgery can an improve quality of life by making important functions—including breathing, eating, speaking—possible in a way they are not for someone with a cleft. 

To learn more about The Waldorf Center for Plastic Surgery and plastic surgery to address a cleft palate or lip, contact Dr. Kathleen Waldorf and her team for answers. Call 520-618-1630 or visit