The information and opinions on this blog come from parents, and the blog is not associated with Primary Children´s Medical Center or any other institution.


This site is specifically for parents of kids with clefts being treated at Primary Children's Medical Center in Salt Lake City, Utah, but I hope that there will be information that is helpful to all parents of kids with clefts. If you are just starting to learn about clefts, I would suggest starting with the "General Information" topic and going from there. To find information on a specific doctor or topic, click on one of the links on the right. You can also search the blog using the box below the topic list. If you have information or experiences to share, please leave comments or contact me to do a guest post at Thanks for visiting!

Sunday, November 1, 2009

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).


  1. I have to say the time span for cleft lip repair is quite a long journey. It needs patience, support and faith in hope definitely.

  2. We just found out my daughters baby may have a cleft palate. Sites like this have been a great comfort, seeing how great the outcome is. Thanks