AtlasSurgeryCleft Lip & Palate Repair

Maxillofacial Surgery

Cleft Lip & Palate Repair

aka Cheiloplasty · Palatoplasty

Staged multidisciplinary reconstruction of orofacial clefts to restore lip continuity, palatal competence, speech, dental occlusion and facial aesthetics.

Lip
3 mo (Millard)
Palate
9–12 mo (Furlow/Bardach)
ABG
8–11 y

§ figuresFigures (2)

Fig. 1SUBIC BAY, Philippines (Aug. 9, 2015) Dr. Freemont Base, an Operation Smile volunteer, performs cleftlip surgery on a Filipino patient aboard the hospital ship USNS Mercy (T-AH 19) during Pacific Partnership 2015. Mercy

“Dr. Freemont Base performs cleft lip surgery” · U.S. Department of Defense Current Photos · Public domain · Wikimedia Commons

Verified open-access images only, reproduced for education under their stated licences · no AI-generated or illustrative artwork · Cleft Lip & Palate Repair figures pending faculty review.

§ overviewOverview

Surgical protocol for correction of cleft lip and/or palate deformities, delivered by a coordinated cleft team from infancy to skeletal maturity.

§ classificationClassification

  • 01Timing protocols: Millard, Delaire, Malek
  • 02Lip repair techniques: Millard rotation-advancement, Tennison–Randall triangular, Fisher subunit
  • 03Palate repair: Von Langenbeck, Bardach two-flap, Furlow double-opposing Z-plasty, intravelar veloplasty

§ planTreatment Planning

  • 01Neonatal: feeding assessment, pre-surgical orthopaedics (NAM)
  • 023 months: lip repair — 'rule of 10s' (10 lb, 10 g/dL Hb, 10 weeks)
  • 039–12 months: palate repair before speech development
  • 04Speech therapy and audiology from 18 months
  • 055–7 y: fistula closure, speech surgery (pharyngoplasty) if VPI
  • 068–11 y: alveolar bone graft (iliac crest) before canine eruption
  • 07Skeletal maturity: orthognathic surgery, rhinoplasty

§ surgicalSurgical Management

  • 01Millard rotation-advancement for unilateral cleft lip
  • 02Bilateral repair: Mulliken or Cutting technique
  • 03Furlow palatoplasty for velar lengthening in VPI
  • 04Secondary alveolar bone graft: cancellous iliac crest

§ complicationsComplications

  • 01Fistula (5–20%)
  • 02Velopharyngeal insufficiency
  • 03Maxillary hypoplasia requiring Le Fort I
  • 04Nasal deformity
  • 05Scarring, dehiscence

§ prognosisPrognosis

Excellent functional and aesthetic outcomes with multidisciplinary team care; lifelong follow-up required.

§ examKey Examination Points

  • 01Assess feeding, weight gain, ear disease
  • 02Evaluate speech resonance and articulation
  • 03Photograph pre/post at each stage

§ revisionQuick Revision Summary

  • 01Rule of 10s · lip 3mo · palate 9-12mo · alveolar graft 8-11y · orthognathic at 18y

§ vivaBDS Viva Questions

  • 01Describe the Millard technique.
  • 02When is alveolar bone grafting done and why?
  • 03What is Furlow palatoplasty?

§ mcqsMCQs — Assessment (3)

Question 1

Optimal age for primary palate repair:

Question 2

Alveolar bone grafting is ideally performed:

Question 3

'Rule of 10s' applies to timing of:

References

  1. Losee JE. Comprehensive Cleft Care 2e

Draft — pending faculty review. Educational use only; verify against current guidelines and primary sources before clinical application.