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.
§ 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:
§ evidenceReferences & Evidence
Current Classification
WHO Classification of Tumours Online — Head and Neck
IARC / WHO · 2022
Continuously updated online edition of the WHO head and neck tumour classification.
Evidence summary
Highest level of evidence linked to this page: WHO / Official Classification.
- L1 · Classification — 1
- L4 · Research — 1
- L6 · Textbook — 4
1 linked source was published from 2024 onwards. Where guidance is limited or contested, rely on the higher-level sources above rather than this summary. Educational use only — not a substitute for clinical judgement.
Content last reviewed
September 2026
Evidence last reviewed
September 2026
Next scheduled review
September 2027
Review status
EVIDENCE REVIEWED
Search latest PubMed evidence
Last literature search: 7 September 2026
Current Classification
IARC / WHO. IARC · 2022
Continuously updated online edition of the WHO head and neck tumour classification.
Key Research
Mossey PA, Little J, Munger RG et al.. Lancet (London, England) · 2009 · 374(9703):1773-85
Seminar reviewing aetiology, epidemiology and multidisciplinary management of orofacial clefting.
Histopathology References
Barnes L. CRC Press · 2008
Detailed histopathological reference for head and neck diagnostic criteria.
Textbook References
Neville BW, Damm DD, Allen CM et al.. Elsevier · 2024
Standard reference textbook of oral and maxillofacial pathology used throughout this atlas.
Rajendran R, Sivapathasundharam B. Elsevier · 2020
Undergraduate and postgraduate oral pathology textbook widely used in BDS and FCPS curricula.
Hupp JR, Ellis E, Tucker MR. Elsevier · 2019
Core surgical textbook covering exodontia, infection, trauma and preprosthetic surgery.
Additional sources cited on this page
- Losee JE. Comprehensive Cleft Care 2e
Draft — pending faculty review. Educational use only; verify against current guidelines and primary sources before clinical application.