Kids who have had surgery for cleft lip/palate seem to have less visible scars than those done a generation ago.
How exactly have surgery methods improved?
In: 1809
Many of the answers here describe advances in surgery in general but not specifically in cleft palate/lip repair.
To answer your question, surgeons used to close the defect by simply pulling the skin together (known as primary closure). The “newer” technique of the last few decades comes not from new sutures or tools (though they are used), but from our improved understanding of embryology – the upper lip unfurls towards the center, and the palate grows towards the center from the sides and has a separate piece that forms a wedge on the anterior. With that knowledge, we now more closely recreate the natural development of the lips/palate using flaps and rotation instead of primary closure. This improves the cosmetic outcome as well as the functional outcome (improved voice and ability to chew/manipulate food with the mouth).
Source: I have a cleft lip and palate, and am also a 4th year medical student going into surgery.
Every toupee you see is a bad toupee. By definition the surgeries 30 years ago that were invisible would be something you would never see. If most surgeries go well you’d only ever see the bad ones.
I am pretty sure results from cleft lip surgeries have been about the same for the past 30 years. 30 years (the 90s) is not that long ago. All of the techniques and instruments used today for cleft lip repair have already been invented (as far as i know). The major technique that surgeons use was invented over 50 years. Cleft lip repair is pretty technologically basic and doesn’t require any special instruments. All you need is a blade, electrocautery, and sutures, which have all existed for much greater than 30 years. Maybe it’s just anectodal from your part. Or maybe I am missing something about the history of cleft lip/palate that a craniofacial surgeon could teach us about.
Have you experienced the future?
I love this question, so interesting. My son learned to crawl in these arm restraints that were meant from keeping him from playing with his lip after surgery. He also frustrated the speech therapist who was trying to get him to say his “TR” sounds…picture of a train? Locomotive. Picture of a truck? Backhoe. I finally just asked her to tell him the word she wanted him to say.
Surgeons got better at them.
Surgeons got better at them.
Surgeons got better at them.
Surgeons got better at them.
Surgeons got better at them.
Surgeons got better at them.
Surgeons got better at them.
Surgeon:
So pretty much every answer here is mostly wrong albeit well intentioned.
1. Technique hasn’t changed in decades. We use the same flap options.
2. Sutures have modestly changed, but not really, and that’s not really a factor here.
3. Da vinci and robot surgery is not a factor here at all, yet.
Timing has changed, but again, this has gone through phases/fads and gone back and forth since the 80s. It’s a push vs pull of speech pathology wanting to allow for speech development (earlier surgery) vs surgeons wanting to wait for skeletal growth.
In general, I’d say scar and outcomes haven’t improved since probably the 90s. They were as good then in the right hands.
Factors that improved outcomes are as follows:
1. Most importantly, the formation of craniofacial teams. Instead of just a surgeon, care is now covered by a multidisciplinary team including specially trained surgeons, maxillofacial surgeon for orthognathic surgery, ENT, orthodontist, dentist, psychologist, speech pathologists, etc. It all makes a difference, even the physical therapy from speech pathology and the phases of orthodontics (braces) change soft tissue outcomes and modify growth. We have a better handle on growth modification than we used to. Braces in general have made massive advances. Cleft surgery is a phases process from 10 weeks old to 17 years old. It’s effectively organized and planned now with individual best suited specialists at each important phase.
2. Better wound care: advanced collagens, PRP, etc
3. You are more likely to have a fellowship trained craniofacial surgeon now, rather than someone who also does clefts. Plastics, ENT, and OMFS all have fellowships now for this, and it’s very competitive. It also sounds sexy and rewarding, so we have about 3 craniofacial surgeons for every cleft patient in the US lol.
Graft material has changed. We have BMP and advanced allografts for palatal grafts now, but autogenous is still the gold standard as it has been for many decades.
The surgery itself really hasn’t changed.
https://plasticsurgerykey.com/a-history-of-cleft-lip-and-cleft-palate-surgery/
I had a cleft lip only surgery at birth in 1984.
I was told that the Shriners paid for it.
I have a noticable scar, and very polarizing looks.
Women either love or hate my face.
I am also 6’3″, and have a nice jaw, so that helps a lot, just being tall.
Would I change it?
In a second, if it would have happened 20 years ago.
Now, I am married to the love of my life, and own a successful business.
My kid was born with a cleft lip and palate. Surprise at birth. It was not caught on ultrasound. While the initial lip adhesion was done as an infant by a plastic surgeon, there is a whole team of specialists we meet with yearly. Plastics, ortho, speech, social worker, dentist, and audiology all have a part. We started with a type of retainer that helps shape the upper jaw into a better position even before the lip surgery. Lip surgery (and nose) was done in the first year. Shortly after healing, the palate was closed. There is still a gap in the jawbone so my 5 year old thinks it’s hilarious to drink water and squeeze it out the nose. In the next year we are looking at orthodontics and a bone graft to close that. There will also be jaw surgery down the line as well as any touch-ups to the nose. A new method I’ve seen pop up is using non-surgical fillers to create facial symmetry. It isn’t as noticeable these days because all of these things together will combine to create look closer to what the patient might look like without the cleft. In years past, a couple of surgeries may restore most function but not enough to “hide” the repair. There are multiple generations of cleft patients in my family and the number of surgeries has increased quite a bit since the 40s but they aren’t all related to the initial split in the lip.
My soon to be born baby has both a cleft lip and minor palate, and it’s something I knew nothing about before hand. The work they are able to perform is absolutely incredible, and has put our minds at ease.
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