Cleft Lip Repair, Primary Bilateral Repair Before & After Photos

This boy is seen after repair of his bilateral cleft lip.

The lip from either side of the cleft is repaired in the midline, with attempt made to reconstruct a more normal appearance of the lip.

At the first surgery, some repair is performed on the nose as well to lengthen the columella and improve the appearance and function of the nasal passage.

This beautiful girl is seen after repair of her bilateral cleft lip and palate.

The orbicularis oris muscle normally completes a ring around the mouth, allowing one to eat without food spilling out, and drinking through and straw.

In bilateral clefts, there is no muscle in the central portion, so the muscle must be brought all the way across from the sides.

This restores function, and helps to bring the premaxilla back in line with the lateral maxillary arches.

Elongation of the columella was also performed in the initial operation to reduce the flat and wide nasal appearance usually seen with bilateral cleft patients.

This lovely girl is seen at 6 months old after her bilateral cleft lip repair.

The first year for our families with cleft lip and palate are the busiest. This may involve NAM (nasoalveolar molding), cleft lip repair, and cleft palate repair.

The timing of these procedures take into account the normal milestones for growth and speech development, to give children the best chance to reach their potential. At the same time, we also aim to minimize the number of surgeries and exposures to anesthesia as we can.

Nothing makes us happier than seeing our patients thriving!

This handsome patient was born with a complete bilateral cleft lip and palate.

He underwent repair of his lip at 3 months of age, and his palate repair at 9 months.

Repair of the orbicularis oris muscle early on helps to bring the central part of the palate and gums back in line with the rest of the gums over time.

He did also have some wider, thicker scars early on, and these improved gradually over time with massage and a steroid injection.

He is seen now, about to celebrate his 2 year birthday!

Why does a bilateral cleft lip happen?

Most clefts are due to random chance in the first couple months after conception.

Normally there is nothing that the parents or families could have done any differently to prevent it. (Some things like smoking, alcohol, or other drugs, can slightly increase the odds.)

The premaxilla is the central part of the upper jaw. It extends from the forehead and nose, growing down from the frontonasal prominence.

From the sides, the lateral maxillary prominences come towards the middle to join with the frontonasal prominence.

When the lip doesn’t fuse on one side, a unilateral cleft lip is seen.

When both sides don’t fuse, a bilateral cleft lip occurs.

When the maxillary prominences don’t meet on the inside of the mouth, that is when a cleft palate occurs. (Specifically, of the secondary palate, the part posterior to the premaxilla.)

This sweet child is seen at 1 month after lip repair, eating well and thriving!

One of our cleft cuties growing up all too quickly!

Cleft lip repair normally is offered at 3-6 months of age.

Palate repair then follows at 9-12 months of age as speech development speeds up. This can also be a good time to perform a tip rhinoplasty while under the same anesthetic, to bring the nasal tip closer together, and helping to round out the nostrils to have more height medially.

Ideally we then wait to perform a definitive rhinoplasty at full skeletal maturity and after any orthognathic surgery that may need to be done to align the upper and lower teeth.