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How are the surgical corrections done?
Through an operation, usually done at an early age (but not necessarily), where the surgeon peels the tissues that covers the bone on both sides of the cleft and attaches the tissues of the two sides together with the help of sutures.

                      

          

What are the post-surgical complications?
SCAR FORMATION. Certain individuals are prone to excessive scar formation. This can be a minor problem, or severe enough to require later treatment. The overwhelming majority of scars heal normally over a reasonable period of time
Hypertrophic scars are raised, red, "angry-looking" scars. Often after a few months these scars become soft and flat and fade in color. Frequently the only treatment required is patience. If after a reasonable amount of time, they are still a problem, cortisone injections, laser treatment or surgical revision may be used to achieve a more aesthetic result.
Keloids are a form of tumor made up of actively growing fibrous tissue. Keloids are a response to trauma (surgical or accidental). Some become itchy or have a burning sensation, which may cause a child to pick at or scratch them. This can worsen the problem.
FISTULA. Despite the best of intentions and techniques, occasionally the healing process after cleft repair is disrupted by the formation of a fistula. A fistula is a hole that allows air and fluids to pass from one space to another. There are many reasons for fistula formation, but the most common causes are infection, trauma from eating the wrong foods, blood clots under flaps of the closure, and tension at the sutured edge of the wound. Some of these, such as tension, may be unavoidable in extremely wide clefts or other circumstances where tissue flaps are moved a long way to achieve closure. Tension can also occur due to crying. Patient’s diet is to be restricted to liquids or soft foods for some period of time after surgery. If blood clots are present in the wound they can provide an environment where it is easy for infections to develop. This may cause the newly formed scar to break down in the post-operative period. Sometimes the patients may disrupt their own wound if they get their arms out of their restraints.

What are the Dental problems associated with clefts?
       It is not unusual for tooth development to be delayed in the child or the tooth maybe congenitally missing, particularly those at the site of the cleft. Clefts most often occur in the alveolar area between the maxillary central incisor (top front tooth) and the cuspid. These children must therefore be examined periodically and treatment plans may have to be modified and often compromised, depending on the severity of the cleft, the growth of the jaws and the status of the developing deciduous and permanent teeth. Some of the teeth adjacent to the cleft may be rotated (twisted) when they erupt. Also common in cleft children is the presence of ectopic (abnormally positioned) teeth. They may be placed in the palate and completely blocked out of the dental arch. Supernumerary (extra) teeth may also be present next to the cleft site. Some emerge into the oral cavity, while others may remain unerupted. The supernumerary may have to be removed to facilitate the treatment of the remaining dentition. Occasionally a tooth may be switched in position with another tooth (transposition). Complete alveolar collapse is quite common in children with bilateral cleft palates, primarily due to scar contraction of the palate. The degree of collapse is variable, but usually the growth of the maxilla (upper jaw) is retarded, resulting in a “dish face”.
Orthodontic treatment is needed to help the growth of the dental arches and correct the malalignment. Prosthodontic treatment may be needed to replace any missing teeth.

What is the need for orthodontic treatment?
       The need of orthodontic intervention is necessary to unlock impacted palatal segments and permit more normal growth. Orthodontic appliances of various types, removable or fixed, in the upper jaw can widen the lateral segments and move the front segment forward. Orthodontic treatment is started between the ages of six to nine. Although it can be done when the milk teeth are in the mouth, most clinicians prefer to wait until the permanent molars (big back teeth) and incisors (front teeth) are present. Once jaw segments have been moved they must be retained (held) either with a removable or a fixed retainer. Further expansion involving "braces" may be necessary when all the permanent teeth have erupted. Orthodontic treatment can do much to establish or approximate the normal dental arch, and then maintain the integrity of that arch. It is often a fairly lengthy, multi-staged process, lasting till adulthood, and later they still may have to undergo Orthognathic surgery. There are 5 reasons for orthodontic treatment on a continuing basis from childhood through adulthood:

1. To provide symmetry in the dental arch of the infant and bony support for the initial nasal and palatal repair.
2. To align the distorted and constricted palatal segments of the maxilla (upper jaw).
3. To maintain the gains made by expansion and dental alignment procedures.
4. To assist the eruption of permanent teeth.
5. To support surgical positioning of the jaws when orthognathic surgery is necessary.

• Fathers, as well as mothers, can pass on genes that cause clefting. A person with an autosomal dominant gene has a 50% probability of passing the gene to an offspring.
• Some clefts are caused by environmental factors, which means it didn't come from Dad or mom.
• Some clefts are related to syndromes. A child with a particular syndrome might have a cleft, but a child with a cleft does not necessarily have any particular syndrome.
• A cleft condition is determined during the 4th to the 8th week of pregnancy. After that critical period, nothing the mother does can cause a cleft and nothing a mother does can avoid the cleft. Sometimes it is determined even before the mother is aware that she is pregnant.
• If it is a cleft in the absence of a syndrome the child is normal in every respect except one, the lip and/or palate did not close during gestation.
• 1 child in 33 is born with some sort of birth defect. 1 in 700 is born with a cleft-related birth defect.
• Most cleft-affected babies are boys, however it is not uncommon for a girl to be born with a cleft.
• If a person (male or female) is born with a cleft, the chance of that person having a child with a cleft rises to 7in 100.
• Clefting seems to be related to ethnicity, occurring most often among Asians, Latinos and Native Americans (1:500), next most often among persons of European ethnicity (1:700) and least often among persons of African ethnicity (1:1,000).
• A child with cleft, faces a promising future. Reconstructive surgery can completely erase the physical reminders of the cleft. Speech therapy can erase any reminders of cleft-affected speech. With the structures repaired and the function restored, the child with a cleft can go on to enjoy a completely normal life.
• It is encouraging to know that through modern technology even the most discouraging configuration of teeth can be transformed into a beautiful smile. After the plan for orthodontic and prosthodontic correction is carried out, the smiles seen in high school portraits can be viewed as small miracles when compared with those in the early photos.