Surgical Management of Cleft Lip and Palate: A Staged Multidisciplinary Approach

Cleft lip and palate are congenital craniofacial anomalies that require coordinated surgical, dental, speech, otologic, nutritional, and psychosocial care throughout childhood and adolescence. The objective of treatment is not only anatomical closure, but restoration of lip competence, nasal symmetry, palatal function, normal speech, maxillary arch continuity, dental development, facial growth, and psychosocial well-being. Primary cleft lip repair is usually performed during early infancy, whereas palate repair is performed later, with timing influenced by the need to support speech development while minimizing adverse effects on maxillary growth. Common unilateral cleft lip techniques include Millard rotation-advancement, Tennison-Randall repair, Mohler modifications, Fisher repair, and other anatomical or triangular flap designs. Palatal reconstruction usually involves closure of the oral and nasal layers with functional reconstruction of the levator veli palatini sling through techniques such as intravelar veloplasty, two-flap palatoplasty, von Langenbeck repair, or double-opposing Z-plasty. Secondary procedures remain common and may include fistula repair, speech surgery for velopharyngeal insufficiency, alveolar bone grafting, cleft rhinoplasty, orthodontic treatment, and orthognathic surgery. Although multiple protocols have been described, current evidence does not identify a single universally superior operative sequence. Optimal outcomes depend on individualized surgical planning, standardized follow-up, multidisciplinary coordination, and long-term assessment of speech, facial growth, dental occlusion, airway function, and patient-reported outcomes.