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I had a friend ask me earlier if Judah would need more surgeries, that it didn't look like he would since his lip and nose have been repaired. I'm sure there are several others that don't understand what all is going on with his clefts and I would like to try and explain here.

First, Judah had a cleft lip which was repaired on January 27th. This surgery repaired his lip and he also basically had a nose job to rebuild the nostril that was flattened by the cleft. He may need a lip or nose revision down the line, when he is much older, based on need; then again, he may never need any more 'plastic' surgery to the outside of his face.

Judah still has a complete bilateral cleft of the hard and soft palate...basically, he has a very large gap in the roof of his mouth that runs from front to back. (Judah's cleft is much wider than this diagram depicts, but it is the clearest example I could find.)

When we go for his post-op appointment on the 23rd of February they will go ahead and set the date for his palate repair. It will most likely be in August or sometime around then...our surgeon generally does the palate repair when the child is 10 months old. To repair a cleft palate,the doctor will make an incision on both sides of the separation, moving tissue from each side of the cleft to the center of the roof of the mouth. This rebuilds the palate, joining muscle together and providing enough length in the palate so he can eat and learn to speak properly.

Sometimes the palate doesn't end up long enough so they require a lengthening surgery to improve speech. Also, the palate may not fuse completely after surgery and leave behind a hole called a fistula which would also need to be repaired later. There are a lot of ifs in that equation, but the only surgery he will definitely have is the palate repair.

He also has a complete cleft in the alveolar ridge. This is the part that holds your teeth. You can see his is all the way over in the right side of his mouth. Now that his lip is repaired the muscles will slowly cause it to migrate left to where it should be. Eventually, it should come all the way over to where it touches the other side, or at least comes close, and he will have a bone graft to fuse the two parts together when he is about 8 years old.

Since he has such a wide cleft he will probably have really wonky teeth. Once his baby teeth start to fall out we will be in touch with orthodontics to make sure there is sufficient bone for adult teeth to attach to. He may have teeth where they aren't supposed to be, like the roof of his mouth, that will have to be surgically removed later. He will also need speech therapy throughout childhood.

In summation, even though Judah now looks 'normal' on the outside, we still have a really long road ahead. There are a lot of variables that can occur for him to require more, but right now we only anticipate two more surgeries. If I have learned anything from his lip repair it's that nothing goes as planned, so I try to do my homework and learn about all the possibilities so I am not surprised. I am glad we have a few months now that we don't have to worry about much, but I am pretty nervous that we'll soon have a date to be dreading for such a long time. Hopefully his next surgery goes more smoothly than the last and there aren't any complications. If you guys have any questions, PLEASE let me know!! A lot of this is kind of hard to understand but I definitely don't mind explaining it.