Surgical techniques

There have been many different surgical techniques and sequences advocated in cleft lip and palate management. Cleft lip repair is commonly performed between 3 and 6 months of age, whereas cleft palate repair is frequently performed between 6 and 18 months.

The Delaire technique and sequence (Table 37.1) is one of many regimes currently practised.

Cleft lip surgery

Skin incisions (Fig 37.7 and Fig. 37.8) are developed to restore displaced tissues including skin and cartilage to their normal position, whilst gaining access to the facial, nasal and lip musculature.

Muscular continuity is achieved by subperiosteal undermining over the anterior maxilla. Nasolabial muscles are anchored to the premaxilla with non-resorbable sutures. Oblique muscles of orbicularis oris are sutured to the base of the anterior nasal spine and cartilaginous nasal septum. Closure of the cleft lip is completed by suturing the horizontal fibres of orbicularis oris to achieve a functioning oral sphincter (Fig 37.9 and Fig 37.10).

Cleft palate surgery

Cleft palate closure can be achieved by one- or two-stage palatoplasty. The surgical principle is mobilization and reconstruction of the aberrant soft palate musculature (Fig. 37.11), together with closure of the residual hard palate cleft by minimal dissection and subsequent scar formation (Fig. 37.12). Excess scar formation in the palate adversely affects growth and development of the maxilla. The philosophy of two-stage closure encourages a physiological narrowing of the hard palate cleft to minimize surgical dissection at the time of the second procedure.