Cleft lip and palate is the most common congenital abnormality of the head and neck. At its worst (cleft lip and palate) children are born with a large gap in the middle of their face with no upper lip, absence or deviation of the lower part of the nose and a hole inside their mouth leading into the nose. At its best (cleft lip) there is a separation of the upper mouth. Unless treated, these children have an unacceptable appearance, difficulty in eating, speaking and breathing and, in a considerable number, hearing difficulties. Cleft lip occurs in about one in 750 live births and is more common in boys, whereas cleft palate, with an incidence of 1 in 2000 live births, is more common in girls. About 50 per cent of all cases have both conditions.
Patients with cleft lip and palate require medical supervision from birth through to adult life; and the attention of many different specialists, including plastic surgeons, orthodontists, oral surgeons, ear, nose and throat surgeons, pediatricians, speech therapists and child psychiatrists. It has become apparent that these patients benefit when managed by a combined team of specialists. Self-help organizations, run by parents of children with these abnormalities, are able to counsel other parents in the difficult period, just after birth, by visiting them at the hospital and at home and by advising them about such problems as feeding. In the repair of cleft lip, modern techniques appreciate that the deformity affects not only the skin but also muscles in the face, the upper jawbone and the nose. The emphasis is to correct as many of these deformities as possible at the initial operation, which usually takes place when the child is about 10 weeks old.
Some plastic surgeons will do a simple lip repair within the first 48 hours after birth, usually as a psychological support to the parents, but final closure is required later on. In the repair of cleft palate, the soft palate is closed around 6 months to a year before speech develops, and it is becoming more common for the surgeon to delay closure of the hard palate so that scarring can be avoided and the upper jawbone can grow normally.