Soft palate closure and lip-nose repair is usually done in one surgery. Closure of the hard palate is performed in a separate surgery.
In a unilateral complete cleft lip and palate, repair of the soft palate, the lip, and the nose is performed in the first surgery at four to six months.
After surgery, a residual cleft will remain in the hard palate. Studies have shown that early closure of the cleft in the hard palate may restrict the growth of the upper jaw resulting in undesired facial appearance and poor occlusion. Therefore, closure of the cleft in the hard palate will not be performed until two to two-and-a-half years. At that age, the hard palate cleft will have reduced in size by growth of the palatal edges and can be closed by a less extensive surgical procedure.
Bone transplant to the alveolus
The last planned operation in children with UCLP will take place at 7 to 9 years when bone grafting is performed. As part of the surgery, bone is taken from the lower leg (Tibia) and transplanted to the cleft in the alveolar ridge. The lateral incisor or the canine is, at that time, on its way to erupt into its position in the cleft area. If the bone is missing, the tooth cannot erupt properly. Once bone grafting is done, it is possible for the tooth to erupt through the grafted bone and can be brought into position by orthodontic means.
More corrections might be necessary in the late teens
After bone grafting, the planned surgical treatment is completed. However, patients will be followed up regularly at 10, 13, 16, and 19 years of age. On these occasions, results from earlier operations are discussed and the patient is informed about possible future secondary corrections.