Cleft lip repair is performed usually in the first couple of months of life. There are several different techniques. The idea for a cleft lip is that you remove the skin in between the cleft itself, you release the muscle, you reattach the muscle, and you put the skin in the lip back together again. Sometimes that connection extends into the nose, and then another flap needs to be thrown to close off the base of the nose from the palate itself. The palatal closure is not performed at that time, however. You typically need to wait a little bit longer until the baby weighs a little bit more. And this is usually around 10 months of age where you can go in, you can release the tissue around the pallet itself, and bring it back to midline and reconnect it and the areas around tend to heal over pretty well. So what you’ve done is you haven’t really gone in to close any bone. You’re just closing soft tissue. For the cleft palates that extend more anteriorly and they come into where the teeth are and you need that close. That’s a little more difficult. Now you’re dealing with boney grafts and dental reconstruction and you end up having to do several revisions over time because these patients tend to form fistulas or other problems that aren’t fixed in one shot.
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