Children with cleft palate can have associated feeding, hearing and speech difficulties. The primary concern for a cleft-surgeon is creating a lip seal to enable the child to suckle milk. But before the child is healthy enough to undergo the surgery, a palatal plate should be given to prevent aspiration of milk from the mouth to the nose, through the cleft in the palate that creates a communication between the mouth and the nose.

The lip repair is attempted as early as the baby is fit enough to sustain the surgery. In the past, Millard’s technique was considered the best in achieving a good lip contour. But it created a scar at the base of the nose. Several surgeons have attempted to remove this scar and Prof. Noordhoff succeeded by taking the ‘C’ flap inside the nose and suturing it in the invisible part of the nose. Prof. Balaji has taken intense training from Prof. Noordhoff in person in mastering the technique.

Earlier, the nose repair was delayed till the cessation of growth. The cleft child had to live with a deformed nose till they are eighteen, but now the focus is on “primary nose repair” where the nose is straightened with lip repair.

The cleft in the palate should be repaired next, before the baby learns to speak, since the palate is the organ of phonation. There are many techniques to repair this defect but the primary aim is achieving a functional repair. The palate is a mobile organ with as many as six muscles attached to it. While performing palatal repair, one can merely stitch the two disconnected halves, as one would presume, but then, the function of the palate would be lost. To achieve a functional repair, the levator palati and the tensor palati muscles, that move the palate, have to be carefully elevated and stitched together. To achieve this, one might even need to osteotomize the delicate Greater Palatine foramen to release the muscles from the pterygoid hamulus. Since these muscles are tiny, extreme care and expertise is needed. This is surgery is very essential for normal speech to develop.