Cleft lip/palate

The precise details of the timing of surgery will vary depending on the individual case. All we can give here are approximations and advise to speak to the surgeon or nurse specialist involved. Some general advice is available for the UK via the website of the Cleft Lip & Palate Association.  

Cleft lip and / or alveolus and / or soft palate repair at three to six months old

Repair of residual palatal defect at nine to twelve months old

Hard palate repair only

Audiology +/- myringotomy (ventilation incision in the ear drum) either at this time or as indicated by audiological assessment

If this is required the child is usually fully recovered within the week.

Pharyngeal surgery if indicated by speech and language therapy assessment at four to five years old

Pharyngeal surgery, if necessary, is very individualised in its progress. If necessary, children seem to recover more quickly than adults but it is uncomfortable and creates issues with swallowing for 10 to 14 days after surgery. The aim of modern cleft surgery is to avoid these operations.

Alveolar bone grafting assessment at age eight years, followed by actual alveolar bone grafting between the ages of nine and eleven

This is a slightly awkward age for children’s surgery as they are reaching one of the tipping points between being a child and an adult in physical growth and psychology. They are also otherwise healthy children who have experienced several operations and many clinical visits (often to busy hospitals).

Definitive orthodontics with or without orthognathic surgery between the ages of 15 and 18 years old

One of the many reasons not to exhaust the cleft patient with multiple interventions throughout childhood is to help them maintain psychological motivation. Another reason is to avoid inhibition of growth, particularly to the top jaw. Despite this a substantial number of cleft patients will have jaw disproportion and/or malalignment. Orthognathic surgery, particularly bimaxillary (2 jaw) surgery is a significant operation.

Definitive rhinoplasty plus definitive restorative dentistry at age 18 years plus

The post osteotomy sequence is very variable and entirely dependent on the individual. So other than to say it may be needed and refer you to the relevant pages (rhinoplasty, restorative dentistry) nothing more can be added by way of timelines.