For parents and professionals
Which complications can occur in surgery for cleft lip and palate – explained in plain language and put in context.
Surgery for cleft lip and palate is well established and performed in specialised centres with experienced teams. Serious complications are rare. As with any operation, complications are nonetheless possible – this page gives an open overview so that parents and professionals can make informed decisions and prepare for counselling at the centre. Frequency, risk and approach are always discussed individually.
Most children come through the procedures well. The following points show what can happen – not what must happen. Every child is counselled and supported individually.
After palate closure a small residual hole (fistula) between the mouth and nose may rarely form, or the wound may partly not heal as planned. Some fistulas cause no symptoms, others let air or fluid pass and are closed in a further operation if needed.
Despite successful surgery, the seal between palate and throat may remain incomplete (velopharyngeal insufficiency), resulting in a nasal sound. This is assessed by speech therapy and can be improved with a further operation if needed.
After palate or throat surgery, breathing may be temporarily more difficult. Pharyngeal flap surgery carries an increased risk of nighttime breathing pauses. Children with Robin sequence or syndromic forms are monitored particularly carefully.
Surgery on the palate can affect the growth of the upper jaw in the long term. Some children later need orthodontic or jaw-surgical correction. This is monitored over years.
Noticeable scars, small asymmetries or a secondary nasal deformity may remain on the lip. Such fine corrections are usually made only after growth is complete.
During bone reconstruction in the alveolar cleft, the grafted bone may partly fail to heal, and infection or a new residual hole may occur. Temporary pain is possible at the donor site (usually the iliac crest).
The items marked KPI are suitable as core metrics for quality assurance.
| # | Complication | Context |
|---|---|---|
| 1 | Oronasal fistula / residual hole after palatoplastyKPI | Most common classic complication; Pittsburgh classification I–VII. |
| 2 | Wound dehiscence after palatoplasty | Partial to complete wound breakdown. |
| 3 | Partial/complete flap loss · palatal necrosisKPI | Rare but serious. |
| 4 | Postoperative bleeding / haematoma | Especially critical if the airway is compromised. |
| 5 | Postoperative airway obstruction | After palate closure/pharyngoplasty, esp. syndromic/Robin sequence. |
| 6 | Infection / wound infection | Risk of dehiscence, fistula, graft loss. |
| 7 | Velopharyngeal insufficiency (VPI) despite palatoplastyKPI | Hypernasality, nasal air emission; secondary surgery if needed. |
| 8 | Hyponasality / overcorrection after velopharyngoplasty | Functionally relevant, often underestimated. |
| 9 | Obstructive sleep apnoea after pharyngeal flap / sphincter pharyngoplastyKPI | About 7–23 % depending on study; pharyngeal flap with increased OSA risk. |
| 10 | Persistent/recurrent VPI after velopharyngoplasty | Flap too narrow, atrophy, wrong indication, large gap. |
| 11 | Maxillary growth restriction / midface hypoplasia | Relevant in the long term after palate/alveolar procedures. |
| 12 | Scar problems after cheiloplasty | Hypertrophic scar, keloid, philtrum/cupid’s-bow asymmetry. |
| 13 | Secondary lip/nose deformity | Vermillion notch, short lip, cleft-lip-nose, septum/alar base deviation. |
| 14 | Complications of alveolar bone graftingKPI | Dehiscence, infection, bone exposure, resorption/graft failure, persistent fistula. |
| 15 | Donor-site morbidity (iliac crest) | Pain, seroma, superficial abscess, fever; usually low but relevant for consent. |
For morbidity recording (quality assurance), suitable core metrics are: fistula by Pittsburgh, VPI or need for secondary speech surgery, obstructive sleep apnoea after velopharyngoplasty, flap necrosis/dehiscence, and failure of the alveolar graft.
Oronasal fistulas are classified by location – from front (labial) to back (uvula):
| Type | Location |
|---|---|
| I | Uvula (split uvula, bifid uvula) |
| II | Soft palate (velum) |
| III | Junction of hard/soft palate |
| IV | Hard palate |
| V | Incisive foramen / Veau IV region |
| VI | Lingual-alveolar |
| VII | Labial-alveolar |
The listed complications are well described in the literature. It is recognised that their occurrence depends on cleft type, surgical technique, timing and individual factors.
Frequency figures differ markedly between studies, definitions and centres (e.g. fistula or OSA rates). Absolute percentages should therefore be interpreted with caution.
Treatment in specialised, interdisciplinary centres, careful indication and structured long-term follow-up help to avoid complications or detect them early.
Frequency figures vary by study, definition and centre. This overview is for information and to prepare counselling; it does not replace individual medical advice. Further sources in the craniofacial library.