Combined early cleft lip and palate repair in children under 10 months – a series of 106 patients

Published:December 28, 2009DOI:


      This article reviews a series of 106 patients presenting with cleft lip and palate who underwent a simultaneous combined cleft lip and palate repair under the age of 10 months. The technique is described together with the early postoperative results. A single surgeon (the author) operated on the 106 patients. The youngest patient was 6 weeks old, and the smallest weighed 2.3 kg. All patients underwent palate repair, followed by lip repair, at a single sitting. The palate repair used the Sommerlad technique with radical muscle repositioning and bilateral lateral Langenbeck-type releasing incisions when indicated. Of the total, 71 patients (67%) had a unilateral lip and palate cleft and underwent a modified Millard repair; 34 (32%) had a bilateral lip defect and underwent a modified Mulliken repair; and one (1%) had a midline cleft lip. Ten patients were excluded from the study, as their palate was deemed too wide to close. Instead, they underwent cleft lip repair and vomer flap to the anterior palate alone. The mean duration of the procedure was 97 min. There was neither mortality, nor significant anaesthetic complications. Two patients who had low oxygen saturation postoperatively were taken back to the theatre. In both cases, the soft palate sutures were removed and the airway improved to a safe degree, permitting return to the ward for subsequent final repair. All patients were discharged home without any ongoing problems. One patient subsequently developed a unilateral dehiscence of a bilateral lip, and seven patients underwent a second procedure to close a palatal fistula. Early follow-up results are encouraging, with only 8% of patients to date requiring a second procedure.


      Although technically challenging, cleft lip and palate repair in a single simultaneous procedure is a successful and, most importantly, a safe procedure, which enables the complete clefting condition to be repaired early and in a single operation.


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        • Sommerlad B.C.
        A technique for cleft palate repair.
        Plast Reconstr Surg. 2003; 112: 1542-1548
        • Millard D.R.
        Complete unilateral clefts of the lip.
        Plast Reconstr Surg. 1960; 25: 595
        • Millard D.R.
        Extensions of the rotation-advancement principle for wide unilateral clefts of the lip.
        Plast Reconstr Surg. 1968; 42: 535
        • Tennison C.W.
        The repair of the unilateral cleft lip by the stencil method.
        Plast Reconstr Surg. 1995; 2: 175
        • Noordhoff M.S.
        The surgical technique for the unilateral cleft lip-nasal deformity.
        Noordhoff Craniofacial Foundation, Taipei1997
      1. Mulliken JB. Primary repair of bilateral cleft lip and nasal deformity. Plast Reconstr Surg 108:181–94.

        • Desai S.N.
        Early cleft palate repair completed before the age of 16 weeks; observation on a personal series of 100 children.
        Br J Plast Surg. 1983; 36: 300-304
        • De Mey A.
        • Malevez C.
        • Mansbach A.L.
        • et al.
        Prise en charge des fentes labio-maxillo-palatines à l'hôpital des enfants Reine Fabiola de Bruxelles.
        Ann Chir Plast Esthét. 2002; 47: 134-137
      2. Wilson J, Hodges AM. Cleft lip and palate surgery at Mengo Hospital, Uganda: Where have all the palates gone? 2008: submitted for publication.

        • Derijcke A.
        • Eerens A.
        • Carels C.
        The incidence of oral clefts: a review.
        Br J Oral Maxillofac Surg. 1996; 34: 488-494
        • Agrawal K.
        • Panda K.N.
        Use of vomer flap in palatoplasty: revisited.
        Cleft palate-Craniofacial Journal. 2006; 43: 30-37