Cleft lip and/or palate affects approximately 1 in 800 babies born today in the United States, though the incidence climbs to 1 in 500 to 600 worldwide. The condition can range from a very mild to a very significant separation in the upper lip and/or roof of the mouth. Surgery to repair a cleft palate is known as palatoplasty.
Timing of cleft lip and palate repair is a subject of some controversy in the medical community, as some compromise must always be made regarding risk, facial growth, scarring, speech development, and psychological factors.
Although there are some differing schools of thought on the matter, most plastic surgeons believe that the ideal patient age for undergoing cleft palate repair surgery is between 6 to 18 months of age (though the favored age for cleft lip repair is generally much earlier, at about 10 to 12 weeks old). This age appears to be advantageous partially because healing times are fast, the patient's memory of the recovery process is short, and the area around the cleft hasn't had much of a chance to develop surrounding tissues in an abnormal manner.
Also important is that this period of time precedes any significant language development. In fact, if the surgery is put off until much later than 3 years of age, development of speech skills may suffer. It is also conceivable that the young child who is unhindered by this defect may find it easier and more natural to develop normal and healthy nutritional habits at this early age.
The main disadvantage to undergoing cleft palate repair at an earlier age is that the risk of complication during and after surgery appears to correlate directly with the patient's body weight at the time of surgery (largely due to anesthesia-related risks). For this reason, surgery on infants is proportionately riskier than surgery performed on older children.
As always, only you and your doctor can weigh the pros and cons to determine what may be the best course of action in your child's case. It is also important to be aware that as your child grows, additionally surgery may be necessary.Sources:
Cleft Palate or Lip, Consumer Information Sheet, American Society of Plastic Surgeons: http://www.plasticsurgery.org/patients_consumers/procedures/CleftLipPalate.cfm
Early Cleft Palate Repair and Speech Outcome, Dorf DS, Curtin JW, Journal of Plastic and Reconstructive Surgery, July 1982, Volume 70(1):74-81
