From Volume 6, Issue 1, January 2013 | Pages 10-12
This article discusses primary surgery for patients with cleft lip and palate, which in the UK would conventionally take place in the first year of life. Current protocols in the United Kingdom are described and some of the history in the surgical specialties that led to their development discussed. The basic principles of the surgery are explained and the impact of surgery on future facial aesthetics, dental development and speech are considered.
Aclefting of the palate has no aesthetic impact, but without adequate repair will lead to an inability to produce normal speech, will impact on hearing and the embarrassment of food and drink escaping through the nose.
The aims of surgery are therefore to produce a result that is both functionally and aesthetically as near normal as possible.
Historically, surgeons concentrated on closure of the clefts at all costs, which led to significant scarring and residual deformity with restricted facial growth (Figure 1).
Closure of the cleft is, however, much more complicated if a functional and aesthetic result is to be achieved. When a cleft occurs, not only is there often a deficiency of tissue, but the associated structures and muscles are also displaced. Surgery therefore aims to close the residual deformity with the minimum of scarring, and also to reposition these structures and, particularly muscles, in their correct orientation to give the best chance of normal function.
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