Editing Cleft lip and cleft palate (section)

===Cleft lip===
Within the first 2–3 months after birth, surgery is performed to close the cleft lip. While surgery to repair a cleft lip can be performed soon after birth, often the preferred age is at approximately 10 weeks of age, following the "[[Millard criteria|rule of 10s]]" coined by surgeons Wilhelmmesen and Musgrave in 1969 (the child is at least 10 weeks of age; weighs at least {{convert | 10 | lb | kg}}, and has at least 10g/dL hemoglobin).<ref>{{cite journal | vauthors = Lydiatt DD, Yonkers AJ, Schall DG | title = The management of the cleft lip and palate patient | journal = The Nebraska Medical Journal | volume = 74 | issue = 11 | pages = 325–8; discussion 328–9 | date = November 1989 | pmid = 2586685 }}</ref><ref>{{cite book| vauthors = Sriram Bhat M |title=SRB's Surgical Operations: Text & Atlas|date=2014|publisher=JP Medical Ltd|isbn=978-93-5025-121-8|page=414|url=https://books.google.com/books?id=ZN7fBAAAQBAJ&pg=PA414|language=en}}</ref> If the cleft is bilateral and extensive, two surgeries may be required to close the cleft, one side first, and the second side a few weeks later. The most common procedure to repair a cleft lip is the ''Millard procedure'' pioneered by [[Ralph Millard]]. Millard performed the first procedure at a [[Mobile Army Surgical Hospital]] (MASH) unit in Korea.<ref>{{cite web |url=http://calder.med.miami.edu/Ralph_Millard/biography.html |title=Biography and Personal Archive |access-date=July 1, 2007 |archive-url = https://web.archive.org/web/20070617215647/http://calder.med.miami.edu/Ralph_Millard/biography.html <!-- Bot retrieved archive --> |archive-date = June 17, 2007}} at miami.edu</ref>

Often an incomplete cleft lip requires the same surgery as complete cleft. This is done for two reasons. Firstly the group of [[muscle]]s required to purse the lips run through the upper lip. To restore the complete group a full incision must be made. Secondly, to create a less obvious scar the surgeon tries to line up the scar with the natural lines in the upper lip (such as the edges of the [[philtrum]]) and tuck away stitches as far up the nose as possible. Incomplete cleft gives the surgeon more tissue to work with, creating a more supple and natural-looking upper lip.

<gallery class="center" widths="150px" heights="150px">
File:Millardrepair1.svg|The blue lines indicate incisions.
File:Millardrepair2.svg|Movement of the flaps; flap A is moved between B and C. C is rotated slightly while B is pushed down.
File:Baby_girl_with_cleft_palate,_smiling.jpg | Pre-operation
File:17161036 POSTOPT3.jpg| Post-operation, the lip is swollen from surgery and will look more natural within weeks. See photos in the [[#Cleft lip|section above]].
</gallery>

====Pre-surgical devices====

In some cases of a severe bilateral complete cleft, the premaxillary segment will be protruded far outside the mouth.

[[Nasolabial fold|Nasoalveolar molding]] prior to surgery can improve long-term nasal symmetry where there is complete unilateral cleft lip–cleft palate, compared to correction by surgery alone, according to a retrospective [[cohort study]].<ref>{{cite journal | vauthors = Barillas I, Dec W, Warren SM, Cutting CB, Grayson BH | title = Nasoalveolar molding improves long-term nasal symmetry in complete unilateral cleft lip-cleft palate patients | journal = Plastic and Reconstructive Surgery | volume = 123 | issue = 3 | pages = 1002–1006 | date = March 2009 | pmid = 19319066 | doi = 10.1097/PRS.0b013e318199f46e | s2cid = 24514123 }}</ref> In this study, significant improvements in nasal symmetry were observed in multiple areas including measurements of the projected length of the nasal ala (lateral surface of the external nose), position of the superoinferior alar groove, position of the mediolateral nasal dome, and nasal bridge deviation. "The nasal ala projection length demonstrated an average ratio of 93.0 percent in the surgery-alone group and 96.5 percent in the nasoalveolar molding group," this study concluded. A [[systematic review]] found in conclusion that nasoalveolar molding had a positive effect on the primary surgery of cleft lip/or palate treatment and aesthetics.<ref>{{cite journal | vauthors = Maillard S, Retrouvey JM, Ahmed MK, Taub PJ | title = Correlation between Nasoalveolar Molding and Surgical, Aesthetic, Functional and Socioeconomic Outcomes Following Primary Repair Surgery: a Systematic Review | journal = Journal of Oral & Maxillofacial Research | volume = 8 | issue = 3 | pages = e2 | date = September 30, 2017 | pmid = 29142654 | pmc = 5676312 | doi = 10.5037/jomr.2017.8302 }}</ref>