The Best Age to Repair a Cleft Lip or Palate

Cleft lip and palate are two of the most common birth defects worldwide today. They affect approximately 1 in 800 babies born today in the United States, though the incidence climbs to 1 in 500 to 600 worldwide.

As a result, surgery to repair a cleft lip and/or cleft palate is one of the most common reconstructive procedures performed by plastic surgeons around the world. The condition can range from a very mild to a very significant separation in the upper lip and/or roof of the mouth. Surgery to repair a cleft palate is known as palatoplasty.

What Determines When a Cleft Should Be Fixed

Many question the age at which it best to have the reconstructive procedure performed to repair this defect. Timing of cleft lip and palate repair is a subject of some controversy in the medical community, as some compromise must always be made regarding risk, facial growth, scarring, speech development, and psychological factors.

The Best Age to Fix a Cleft Lip or Palate

Although there are some different schools of thought on the matter, most plastic surgeons believe that the ideal patient age for undergoing cleft palate repair surgery is between 6 to 18 months of age (though the favored age for cleft lip repair is generally much earlier, at about 10 to 12 weeks old).

This age appears to be advantageous partially because healing times are fast, the patient's memory of the recovery process is short, and the area around the cleft hasn't had much of a chance to develop surrounding tissues in an abnormal manner.

Also important is that this period of time precedes any significant language development. In fact, if the surgery is put off until much later than 3 years of age, development of speech skills may suffer. It is also conceivable that the young child who is unhindered by this defect may find it easier and more natural to develop normal and healthy nutritional habits at this early age.

Risks of Surgery

The main disadvantage of undergoing cleft palate repair at an earlier age is that the risk of complications during and after surgery appears to correlate directly with the patient's body weight at the time of surgery. For this reason, surgery on infants is proportionately riskier than surgery performed on older children. As with any surgical procedure, there are risks. In this case, complications can include:

• Bleeding (hematoma)
• Infection
• Poor healing of incisions
• Irregular healing of scars including contracture (puckering or pulling together of tissues)
• Residual irregularities and asymmetries
• Anesthesia risks
• Allergies to tape, suture materials, and glues, blood products, topical preparations or injected agents
• Damage to deeper structures — such as nerves, blood vessels, muscles, and lungs — can occur and may be temporary or permanent
• Possibility of revisional surgery

As always, only you and your healthcare provider can weigh the pros and cons to determine what may be the best course of action in your child's case. It is also important to be aware that as your child grows, additional surgery may be necessary.