Trusted medical platform in Jordan
عملية إصلاح الشفة المشقوقة والشق الحلقي
Cleft lip and cleft palate are congenital conditions that arise before birth when the tissues of the lip or the roof of the mouth do not fuse completely. A cleft may involve the lip alone, the palate alone, or both, on one side or on both sides. Repair is not a single operation but staged care that begins in the first days of life and continues for years with a team: a maxillofacial or plastic surgeon, a paediatrician, a feeding specialist, a speech and language therapist, an ear nose and throat doctor, a dentist and an orthodontist. The first priority is not appearance but feeding and growth. Most babies need specially shaped teats and bottles, a modified feeding technique, and careful weight monitoring. Parents are told clearly that a cleft is not the result of anything the mother did wrong and is not a reason for blame, a widespread and harmful belief, and that with organised care most children grow, speak and live entirely normal lives. Usual timing is lip repair at around three to six months of age and palate repair between about nine and eighteen months, depending on the child's growth, weight and the team's judgement. In selected cases, appliances that shape the nose and gum precede surgery. Operations are performed under general anaesthesia after a full preoperative assessment. The limits must be stated plainly. One operation does not complete the journey. A surgical scar always remains, although it usually fades considerably with time and care. Palate repair improves speech, yet a proportion of children need prolonged speech therapy or an additional procedure to reduce air escaping through the nose while speaking. Middle ear problems are common and require hearing follow-up, and later the child may need orthodontic treatment, a bone graft to the gum area, and in some cases jaw surgery in the teenage years once growth is complete. At every stage the decision rests on examining the child, their weight and general condition and the team's assessment, not on a fixed age applied to all children.
The baby is examined to establish the type and extent of the cleft, associated anomalies are looked for, and parents are trained in an appropriate feeding technique with special bottles, with weight monitoring, because good growth is a precondition for safe surgery.
In selected cases, moulding appliances are used to bring the cleft edges closer and improve the shape of the nose and gum before surgery, alongside investigations, a paediatric anaesthetic review, and confirmation that the child has no active respiratory infection.
Usually performed at three to six months under general anaesthesia, the layers of the lip, skin, muscle and mucosa, are restored to their correct arrangement so the lip regains its shape and its function in closure, feeding and later speech.
Usually performed between nine and eighteen months, the roof of the mouth is closed in layers and the muscles of the soft palate are realigned. This step underpins speech development and reduces air escape through the nose.
Speech therapy, hearing tests, middle ear health and the growth of the jaws and teeth are followed over years, with planning for orthodontics, a gum area bone graft when needed, and possibly jaw surgery once growth is complete.
Tell the team your child's current weight and growth curve, any medicines they take, any diagnosed heart, respiratory or other anomaly, and any family history of anaesthetic problems. Postpone and inform the surgeon if your child has had a fever, cough, cold or diarrhoea in the preceding days, because active infection raises anaesthetic risk. Follow the fasting instructions precisely according to age and feed type, since fasting rules differ for milk and for clear water, and do not improvise. Bring the special bottles, comfortable clothing and a comfort item, plan for one parent to stay in hospital, and ask in advance which feeding method is allowed after surgery.
Expect swelling of the lip or mouth for some days and more crying than usual in the first two days. Feed your child only by the method the team specified, put nothing hard, sharp or metallic such as a spoon into the mouth, and stop them rubbing the face or placing fingers or toys in the mouth; gentle elbow restraints may be advised for a limited period. Clean the surgical line exactly as taught, gently and without rubbing, keep it moist if instructed, and give pain medicine at the times the doctor set. Attend every follow-up, speech therapy and hearing appointment. **Seek care immediately if there is difficulty breathing or any bluish colour, refusal to feed with a clear drop in fluids or wet nappies, fever, bleeding from the mouth or nose, opening of the surgical line, pus or a foul smell, or unusual drowsiness.**
Lip repair usually takes one to two hours and palate repair two to three hours, with a hospital stay of one to three days for each operation. The complete pathway of follow-up, speech therapy and dental care extends over years until growth is complete.
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