cleft lip before and after surgery progression

Lehigh Valley parents always have high hopes for their children. They want them to have a fun, memorable childhood and make great, lifelong friends. They want them to do brilliantly in school and find the passions that make them tick. And finally, they want them to grow up to have great careers and build families for themselves.

Before any of this, parents want their children to be born with 10 fingers, 10 toes and everything else necessary to be healthy. You’ll love your child no matter what, but few are ready for craniofacial conditions such as orofacial clefts. These include cleft lip, cleft palate or a combination. The good news is that orofacial cleft conditions are often detectable prior to birth, which allows your family to become informed, prepared and choose a course of action right away.

Cleft lip and palates are birth defects that occur when the facial tissues don’t develop and join properly while in utero. Near the nose, the upper lip may not completely connect, while the palate may have a gap along its center. This split is termed a “cleft.” When left untreated, these conditions can cause speech problems and difficulty eating, along with hearing impairment and ear infections. In the worst of cases, a few thousand deaths occur each year, making treatment even more important. Because of the condition’s location, it also can be a source of insecurity for both the child and parent alike.

While the condition may seem daunting at first, it’s important to remember the following: cleft palate and lip repair is one of the most consistently successful surgeries performed. Read on to learn history about the procedures, a guide to how modern surgery will be performed and tips for how you can support your child regarding his or her condition.

History of Cleft Lip and Palate Surgery

An orofacial cleft is an old medical condition, thus the procedures have had a great deal of time to be refined. Unfortunately, defects from orofacial clefts were at one point held with great superstition. Therefore, many children did not receive the care they deserved. For cleft lips, the earliest documented case of a cleft lip surgery dates to 390 BC in China. A soldier-to-be, Wey Young-Chi was the patient at 18 years old. Several documented cases have been found throughout the middle ages, and modern refinements to the procedure began in earnest starting in the 19th century, with French surgeon Germanicus Mirault considered the foremost pioneer of the surgery. In the 1950s, surgeons C.W. Tennison, Peter Randall and Ralph Millard are considered to have made more recent refinements that serve as standards for today.

Cleft palates have always been a more complex condition to solve, due to location and the more invasive nature of the procedure. Research has shown the first found record of a palatal operation is from the beginning of the 6th century, when treatment was performed on an inflamed uvula. The 1500s saw the advent of suturing palatal clefts, while cauterizing for cleft velums was incorporated in the 18th century. Like cleft lip repair, cleft palate surgeries benefited greatly from the advances medicine saw during the mid-1800s. Bernhard von Langenbeck was a German surgeon known for being brilliant and bold, and is considered the father of surgical residency. His brilliance extended into the realm of cleft palates when he developed the procedure that now bears his name. Von Langenbeck created a bipedicle flap along the palate from the mucous membrane and hard bone that comprise the palate. The flaps were then sutured together along the middle of the mouth. Because of its efficacy while also allowing for quality blood flow, the technique is still used today in isolated palatal repairs. But its impact went beyond being a procedure – the von Langenbeck technique helped set the groundwork for many other techniques for cleft palates, including Bardach’s two-flap technique and the Vomer flap.

Around a dozen or so techniques are regularly used in modern palate repair. If you’re interested in learning more about these or the technique for repairing cleft lips, St. Luke’s maxillofacial surgeons are more than happy to be used as a resource. But rather than continue to delve into the fascinating history of the surgeries, read on to learn what can be expected along the path of orofacial cleft surgery.

What to Expect from Cleft Lip and Cleft Palate Surgery


Before having your child go through with an orofacial cleft surgery in Lehigh Valley or elsewhere, it’s important to understand how the procedure will go. If you have any questions, never be afraid to ask. At St. Luke’s OMS, we prefer for our patients and their families to be as informed as possible. Contact us if you have any potential questions before moving forward.

Prior to the surgery, medical staff will give your child a pre-surgical checkup to ensure that he or she is healthy enough for surgery. Barring any issues, your child will be prepped for surgery and then provided medication to improve his or her comfort level. This typically means intravenous sedation and general anesthesia. St. Luke’s always makes sure to inform parents what will be used, based on the doctor’s recommendation.

Once the child is asleep, the procedure will depend on whether the cleft is based in the lip, the palate or both. If it’s the lip, the goal will be to improve the upper lip’s appearance and function as much as possible. To do this, incisions will be made on either side of the cleft to create the flaps that will be stitched together. These will be lined up with the natural contours found above the upper lip to minimize any scar appearance in the future. Cleft lip surgery can be performed at a much younger age than a cleft palate surgery, in which the child being older makes the surgery more tolerable because the mouth has had more time to develop.

If your child has been born with a unilateral cleft lip or unilateral cleft lip and palate, St. Luke’s may recommend nasoalveolar molding prior to surgery. This appliance is a combination of a palatal plate and sinus stent that have been custom-made specifically for your child. A NAM will be gradually tightened and adjusted, until your child’s palate and/or lip are in the best state possible prior to surgery.

For cleft palates, the goal of surgery will depend greatly on the state of the craniofacial condition. In the case of more standard cleft palates, a surgeon will carefully reposition the tissues and muscles as close as possible to the cleft. As with the cleft lip, incisions will be made on each side of the cleft to create flaps, which will then be used to suture the two sides of the cleft together. When done properly, the palate will be long enough for safe feeding, aid in normal speech development and allow for continued growth through the rest of the child’s maturation.

In some children, a bone graft and palatal expansion may be necessary to fix a clefting of the gum. Others still may need an intermediate rhinoplasty surgery for nasal defects. Also, in many cases children will need revision surgery or orthodontic work to promote function and minimize any remaining scarring.

Each person and condition is going to have his or her unique qualities. This is part of the beauty of being human. But to get a strong understanding of exactly what needs to be done for your child, it’s important to find your local orthodontist in Lehigh Valley to assess the conditions and cultivate a quality course of action.

Raising a Healthy Child, Mentally as Well as Physically

boy having fun at a partyWhen you have a child with a craniofacial condition, there can be times when you, as a parent, may feel defeated or helpless. But just because your child is under the care of medical professionals doesn’t mean that you’ve been relegated to the sidelines. A child born with an orofacial cleft has a journey ahead of him or her, and it’s up to the parents to promote a healthy mental state.

For starters, just because your child has a craniofacial condition, it doesn’t mean that he or she won’t be able to lead a normal, healthy life. People with cleft lips and palates have regularly gone on to be wildly successful, whether it’s in business, politics, medicine, sports or entertainment. When was the last time you heard someone focus on quarterback Peyton Manning’s cleft? Or funny man Cheech Marin? Worried about their speaking abilities? That didn’t stop Tom Brokaw, whose career has been in part dictated by his oratory skills. The point is, orofacial clefts are a hurdle which will make your child stronger. He or she may have special medical needs, but he or she has the cognitive ability of anyone else. Do not hold your child back, treat him or her like anyone else, and hold him or her to the merit of his or her actions, not what makes him or her medically unique.

If your child is dreading medical visits and procedures, imbue the experiences before and after with joy and fun. For older kids, plan trips to the zoo before or take in a movie later. And since many cleft-related surgeries happen when children are younger, never let his or her condition hold your child back from experiencing the world following surgery. What he or she was born with should not define your child. In most cases, it becomes an afterthought.

Parents have the power to impress upon their children, and that means your positivity will resonate with your child. Unfortunately, some children with orofacial clefts still battle insecurity and psychological distress due to these conditions. Keep an eye on your child – if he or she seems to struggle, it may be time to consider a therapist. If you desire, your orthodontist will be able to provide you with a referral for a professional experienced in dealing with medical conditions.

Learn More About Cleft Lip and Palate Options in the Lehigh Valley

At St. Luke’s OMS in Pennsylvania’s Lehigh Valley, few cases are as rewarding as bringing a smile to a child. If your family is looking for a consultation with one of our medical staff, please call us today at 610-865-8077. At our offices in Allentown, Bethlehem, Easton and Stroudsburg, we are always happy to answer any questions you may have.