When is the best time for operation of cleft lip and palate?

When is the best time for operation of cleft lip and palate: at the age of 6 months or later?
Doesn’t the reconstruction of the palate in the first year of life create
problems in the development of the jaw and the face of the child?
Isn’t a method of firstly reconstructing the lip and re-establishing the palate in the second year of life safer?

The complete, incomplete or submucosal cleft is a disruption of the continuity of the muscles complex, which correct functioning is responsible for breathing, swallowing and most of all for speech, hearing and the development of the oral cavity, the nose and the throat. The longer those bad conditions are present the more developmental disorders emerge. That influences the above mentioned functions. It is obvious then that it is essential to restore the balance, since so much depends on that. The problem is how to operate, so that the operation – which improves amongst other things the tightness between the nose and the oral cavity – would be effective for the development of the speech and wouldn’t damage the growing jaw and teeth. It has to be said, that the operations, during which the surgeon is able to close all the wounds in the palate tightly are the least traumatic and lead to very good results. The surgeons, who delay the operation until 2nd and 3rd year of age usually use such way of operating that they leave the wounds around growing teeth unsutured, which actually deteriorates the conditions for the correct dental occlusion. Adding to that complications e.g. in form of a small hole in the palate, which can be closed only after a year following the primary operation, then we are almost sure that the new scars will deteriorate the existing situation. Especially since at the age of 3-4 a child enters the phase of active development of the jaw. The more operations on the palate the worse the dental occlusion and correct development of the jaw.

To sum up:

  1. The operation should be done as soon as possible – at best during the first year of age.
  2. The palate should only be operated once and all the wounds should be sewn tightly.

Such procedures create conditions for a correct development of the speech and for positioning the teeth in proper places. When we talk about the cleft lip and palate, today after 30 years of experience I think that the lip and the palate should always be operated in one-stage procedure, before the first year of age, at best when the child is 6 months old.

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