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CLEFT LIP AND PALATE SURGERY

Cleft lip and palate are birth defects that are best treated by a team of specialists in different fields, including orthodontics, plastic surgery, oral and maxillofacial surgery, ENT surgery, pediatrics, psychology and speech therapy. In the field of reconstructive surgery, Dr Huang specializes in the surgical treatment of cleft lip and palate. He is a member of the Singapore International Cleft-Craniofacial Team (SICCT, http://www.sgcleftteam.com).

Cleft Lip Repair, Gingivoperiosteoplasty (GPP) And Primary Rhinoplasty

This procedure is done in conjunction with Naso Alveolar Molding (NAM), which is carried out by Dr Catherine Lee (www.DrCatherineLeeOrthodontics.com).

NAM involves having the cleft baby wear a device from as early as possible after birth that narrows the cleft of the lip and the alveolus (gum bone). It also reduces the nasal deformity associated with the cleft lip.

By reducing the severity of all three aspects of the cleft, it then becomes possible to surgically repair the (1) cleft lip (cleft lip repair), (2) the cleft alveolus (gingivoperiosteoplasty, or GPP), and (3) the cleft lip nasal deformity (primary rhinoplasty) in a single, 3 in 1 operation, using advanced surgical techniques.

It is highly advantageous to be able to do this, because it means that alveolar bone grafting (see below) and a secondary cleft rhinoplasty (see below) may not be required later, thus potentially saving the patient from two operations later in life. The repair is usually carried out at about 3 months of age.

Cleft Palate Repair

If the child has a cleft palate, this is repaired at 9 to 12 months of age. Dr Huang has done award winning research on cleft palate and is an expert in the anatomy of cleft palate, having published several scientific papers in international plastic surgery journals and written a book chapter on this subject.

There are two main goals in cleft palate repair: to repair the physical cleft so that food and liquids will not spill from the mouth into the nose, and to realign the muscles of the soft palate so that they will function better for speech.

As with the 3 in 1 repair, Dr Huang uses advanced surgical techniques to repair the cleft palate and realign the muscles of the soft palate that are vital for speech. This maximizes the chance of the child having normal speech.

Speech Surgery following Cleft Palate Repair

If the child has speech problems despite an adequate cleft palate repair, further surgical procedures may be necessary later in childhood to improve speech function. These involve using tissues from behind the tonsils to make it easier for the soft palate muscles to do their job during speech.

Alveolar Bone Grafting

The cleft in the alveolus (gum bone) must be repaired so that it can support the tooth that erupts in that location. If it a GPP was not done during infancy, this repair is carried out at ages 8 to 10 years, just before the permanent teeth erupt. Bone is harvested from the hip and used to as a bone graft to repair the alveolar cleft.

Cleft Orthoganthic Surgery

Cleft lip and palate are often associated with insufficient growth of the upper jaw. This can result in an abnormal bite and appearance. Non-surgical orthodontic techniques can sometimes stimulate adequate growth of the upper jaw.

Otherwise, orthognathic (jaw) surgery involving the upper jaw, lower jaw or both may be required to reposition the jaws optimally for both function and appearance. Orthognathic surgery must done in conjunction with orthodontics (wearing braces) in order to achieve correct positioning of the jaws and teeth. It is usually carried out when the patient is a teenager, after the completion of growth.

Secondary Cleft Rhinoplasty

If there remains a significant nasal deformity associated with the cleft later in life, a secondary cleft rhinoplasty may be required to improve the appearance of the nose. This is typically completed when the patient is a teenager, after the jaw surgery (if that was required). While it is difficult to make the nose look completely normal, Dr Huang has found that many of the principles and techniques of cosmetic rhinoplasty are applicable and effective in cleft rhinoplasty, and they help to produce better results.

CRANIOMAXILLOFACIAL SURGERY

Dr Huang’s other area of specialization in reconstructive surgery is craniomaxillofacial surgery. This includes orthognathic surgery (see section on cleft lip and palate above). It also includes craniomaxillofacial trauma, or fractures of the facial bones. Dr Huang combines the sophisticated techniques of craniomaxillofacial surgery with his expertise in cosmetic surgery of the soft tissues of the face to repair all kinds of facial injuries (to the bones and soft tissues), and to restore form and function as optimally as possible.