Surgery Timeline: Dr. Morales

Here is the general surgery timeline that Dr. Morales gives out to parents during the first appointment (with a few footnotes from me). The other local doctors' timelines are vaguely similar, and as always, this will vary depending on your child.

Cleft Lip Only:
6-8 Weeks              Lip & Nose Repair
6 1/2 - 7 Years       Possible Lip & Nose Revisions

Cleft Palate Only:
9 Months                Hard & Soft Palate Repair
                              (or adhesion with palatal prosthesis if cleft is wide)
18-24 Months        Soft palate z-plasty*
                              Complete Closure (if previous adhesion)
8-14 Years             Midface Advancement (if malocclusion)
                              Distraction v. Orthognathic**

Cleft Lip & Palate:
6-8 Weeks             Premaxillary repositioning,
                              Palatal Prosthesis (weekly adjustments 1-2 mos.)***
3-4 Months            Lip & Nose Repair, Palatal Prosthesis
9 Months                Soft Palate Repair
                              (muscle z-plaxty or adhesion if wide),
                              Palatal Prosthesis
18-24 Months        Soft Palate z-plasty* (if previous adhesion),
                              Palatal Prosthesis
4 Years                  Hard Palate Repair
6 Years                  Alveolar bone graft (if gumline involved),
                              Closure Nasolabial Fistula****
6 1/2 - 7 Years      Nose & Lip Revisions
8-14 Years            Midface Advancement (if malocclusion)
                              Distraction v. Orthognathic*

*Z-plasty is a type of plastic surgery, and refers to the shape of the incision/where two tissues are stitched together.

**Malocclusion is a general term when there is a misalignment of the teeth for any number of reasons. With cleft palate children, the upper jaw often is stunted in growth because it is being pulled together to repair the cleft. So in some cases, a "Midface Advancement" is undergone to pull the upper jaw forward into alignment with the lower jaw. There are two methods of doing this: Distraction and Orthognathic Surgery. Both involve cutting and realigning the jaw bone to the desired position. 

***This is a prosthesis that goes in the hard palate to pull together the hard palate. In the case of a cleft that goes through the gumline and lip, a plastic chain (kind of like what you'd see with braces) is attached from the prosthesis to the premaxilla, or the gumline in the front, to pull it to the correct position in preparation for the lip repair. The article on the maxilla, as well as the links from it, may be helpful for an anatomy review.

****The alveolar ridge is essentially the gumline, and a bone graft allows for completion of the gumline and will also facilitate implants in spaces where there are missing teeth. A fistula is essentially a hole that connects two organs that normally aren't connected. In the case of children with clefts, often a fistula will open up in their palate after surgery, connecting the nose and mouth or lip (thus the term nasolabial, or nose-lip).