Why Is Jaw Surgery Needed After a Cleft?
People born with a Cleft Lip and Palate often have an underdeveloped upper jaw (midface hypoplasia), which gives a flat or ‘dish face’ profile. It also causes an abnormal bite: an underbite, or Class III malocclusion. Jaw (orthognathic) surgery corrects both the bite and the appearance of the face.
When Is It Done?
After 16 years of age, when the facial bones have finished growing. Your surgeon and orthodontist decide the timing by monitoring jaw growth. Orthodontic treatment (braces) is needed for 6 months to 1 year before surgery, and for 3–6 months after.
Tests and Planning
An OPG (a specialised X-ray of the jaws), a lateral cephalogram and a CT scan are taken. The operation is planned on specialised software using virtual surgical planning, which is also used to prepare the models and splints needed in theatre. Most patients need all wisdom teeth removed beforehand.
Types of Surgery
- Le Fort I maxillary advancement — the upper jaw is cut and moved forward to correct the bite and improve the facial profile.
- Double-Jaw Surgery — depending on the deformity, the lower jaw may also be moved back, combined with the Le Fort I advancement, to achieve the same correction.
What the Surgery Involves
You are seen by the anaesthetist before surgery and admitted on the day of the operation, which takes about 2–3 hours under general anaesthesia.
The jaws are cut, moved into the correct position and fixed with titanium plates and screws. All incisions are inside the mouth, so there are no scars on the face. The wounds are closed with absorbable stitches.
After Surgery
- One night in the ICU, then the ward.
- Mild oozing of blood from the mouth is normal; soft diet for 3 weeks, with regular mouthwashes.
- Home after 3–4 days, with rubber bands fitted to the braces.
- Wound check after 1 week; the stitches are absorbable. Orthodontic treatment continues for 3–6 months once healed.
Possible Complications
Infection, bleeding, swelling and pain are the common complications; pain in hospital is managed by the acute pain service team. Numbness of the upper and lower lip from stretching of the nerves is common and temporary, though full recovery can take 6 months to 1 year. Speech can worsen after surgery and speech therapy may be needed; very rarely, Speech Surgery is required. Loss of teeth is a rare complication that may need dental rehabilitation.
See also: Orthognathic (Jaw Correction) Surgery — Le Fort I, BSSO, Double-Jaw Surgery and Genioplasty for bite problems and facial balance.
Frequently Asked Questions
At what age is jaw surgery done for cleft patients?
After 16 years of age, once the facial bones have finished growing.
Will there be scars on the face?
No. All incisions are inside the mouth.
Is the lip numbness permanent?
It is usually temporary, but full recovery can take 6 months to a year.
How long will braces be needed?
Usually 6 months to 1 year before surgery and 3–6 months after.
Related Cleft Lip and Palate Procedures
- Cleft Lip Repair — Lip repair at 3–6 months: the operation, feeding and scar care.
- Cleft Palate Repair — Palate repair at 9–12 months, with speech and hearing follow-up.
- Speech Surgery — For nasal speech that persists after therapy, usually from age 5–6.
- Alveolar Bone Grafting — Bone graft to the gum gap at 7–11 years, timed to the canine tooth.
- Cleft Rhinoplasty — Nose and septum correction after 18 — usually the last cleft operation.
This page is general information written by Dr Vybhav Deraje for patients and families. It does not replace an individual consultation; treatment depends on clinical assessment.