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Cleft Lip, Palate & Nasal Surgery
Overview
Cleft lip and palate occur when parts of the upper lip and/or the roof of the mouth do not fully fuse during early fetal development. These conditions can affect a child’s appearance, speech, feeding, breathing, and psychosocial well-being.
Cleft lip and palate surgery is performed to restore function and improve facial aesthetics. This is often a staged process, involving multiple procedures over the course of childhood and adolescence. Nasal correction is typically included as part of cleft repair, either in early surgery or through specialized nasal reconstruction later in life.
At Facial Plastic Surgery at New England Ear Nose & Throat, we take a comprehensive, multidisciplinary approach, ensuring each child receives individualized, age-appropriate care for optimal outcomes in both function and appearance.
Indications
Surgery is typically indicated for infants, children, and occasionally adults with:
- A cleft lip (unilateral or bilateral)
- A cleft palate (involving the hard and/or soft palate)
- Combined cleft lip and palate
- Nasal deformities associated with clefts
- Difficulty with feeding, speech, or breathing
- Visible deformity or asymmetry affecting self-confidence
- Revision needs from previous cleft surgery
Benefits
Cleft surgery offers a range of functional, aesthetic, and emotional benefits:
- Restores Oral and Facial Function: Enables proper feeding, breathing, and speech development.
- Improves Facial Appearance: Enhances symmetry, especially in the nose, lips, and smile.
- Boosts Confidence: Reduces social anxiety and improves self-esteem, especially during school years.
- Reduces Risk of Complications: Prevents hearing problems, speech delay, and dental issues.
- Supports Long-Term Development: Provides a foundation for healthy facial growth and proper jaw alignment.
Primary Reconstruction
Cleft treatment is typically staged over several years, beginning in infancy and continuing into adolescence:
- Cleft Lip Repair: Usually performed between 3–6 months of age to close the lip gap and realign the muscle and skin. This also improves nasal shape and symmetry.
- Cleft Palate Repair: Usually completed between 9–18 months of age. It closes the gap in the roof of the mouth to support speech and feeding.
- Nasal Reconstruction: Nasal cartilage and shape are often affected by clefts. Nasal reshaping is done in early surgery and further refined as the child grows.
- Revisions and Alveolar Bone Grafting: Additional surgeries during childhood or adolescence may be needed to improve aesthetics, function, and support permanent teeth.
Care often involves a team of specialists including surgeons, orthodontists, ENT doctors, audiologists, and speech-language pathologists. Dr. Shehan collaborates with the Boston Cleft Collaborative, with a team including members from Massachusetts Eye & Ear Institute and Boston Medical Center.
Techniques Used
We use the most advanced surgical techniques to optimize outcomes and minimize scarring:
- Millard and Mohler Techniques for lip repair to restore natural contours
- Furlow Double Opposing Z-Plasty or straight-line techniques for palate closure
- Primary Rhinoplasty at the time of lip repair for early nasal symmetry
- Secondary Nasal Reconstruction in the teen years or after growth is complete
- Alveolar Bone Grafting using bone from the hip to support tooth eruption and jaw development
- Minimally visible incisions placed in natural creases to reduce scarring
Our approach is always tailored to the individual, with attention to symmetry, speech development, and long-term facial harmony.
Frequently Asked Questions
What causes cleft lip and palate?
Clefts occur during early fetal development and can be due to a combination of genetic and environmental factors. They are often detected through prenatal ultrasound.
Is the surgery safe?
Yes. Cleft surgery is highly specialized and safe when performed by an experienced facial plastic or pediatric surgeon. We use general anesthesia in a hospital setting with pediatric anesthesiologists.
Will my child need more than one surgery?
Most children require staged procedures, especially if both the lip and palate are involved. Additional surgeries may be needed for nasal correction, speech, and dental development.
What kind of scar will my child have?
Scars are placed along natural facial lines and typically fade very well over time. Revision or laser treatments can be used later if needed.
Can cleft surgery improve speech?
Yes. Closing the palate is essential for proper speech development. We also work with speech therapists postoperatively to support language and articulation skills.
Expert Care for Cleft Lip, Palate, and Nasal Surgery
If your child has been diagnosed with a cleft lip, cleft palate, or related nasal deformity, we’re here to help. Our team provides expert, compassionate care to guide your family through every step of the treatment journey.