Chapter 12: Further Surgery

Following repair of unilateral clefts, little, if any, additional surgery is required. Sometimes the original repair of the lip can be improved upon and this is often done before your child starts school. Both parents and the treating team should keep an open mind about the need for any further treatment that can make the final result better.

Sometimes in very wide unilateral clefts some further surgery before school age is necessary, but usually any adjustment will be done when your child is a teenager. In bilateral cleft lips, again some early surgery may be necessary to release the tip of the nose from the lip (as a 'forked flap') at about the age of 5 or 6 years.

Often, orthodontic treatment needs to be supplemented by surgery to the upper jaw (see Section 17 on orthodontic treatment). A bone graft is used to fill the space in the upper jaw at the site of the cleft, to allow for normal tooth eruption. Any small holes (fistulae), which can allow leakages of food or fluid to the nose, can also be sealed at this time. Such surgery often takes place at about 9 or 10 years of age.

Once nasal growth has ceased at about 16-17 years of age, a rhinoplasty to narrow the nose and adjust the tip of the nose will sometimes be indicated. At this time surgery to the septum, which may be blocking one side of the nose, can also be carried out.

In a few cases, further surgery may be required on the upper jaw to improve appearance or dental function in later teenage years.

12.1 Before and after Pharyngoplasty and pharyngeal flap surgery.

Further Information

To obtain further information on "Cleft Lip and Palate: A Parent's Guide", please contact Belinda Liston:

Belina Liston
Cleft Palate Clinic Coordinator
The Cleft Palate Clinic
The Children's Hospital at Westmead
Locked Bag 4001
WESTMEAD NSW 2145
AUSTRALIA
T: + 61 2 9845 2079
F: + 61 2 9845 2078
E: BelindaS4@chw.edu.au