Which defect is repaired FIRST in a patient with cleft lip and palate, and at what age is that repair conventionally scheduled?

Correct answer: C. The lip, at approximately 3 months

• A. The palate is not repaired first, and 3 months is too early for it. Operating on the palate at that age carries a high risk of scarring across the growing maxillary suture, which restricts midface growth.
• B. The age range is right for the palate, but the palate is not the FIRST repair. Palatoplasty follows cheiloplasty, timed before meaningful speech development begins so that velopharyngeal competence is established in time.
• C. CORRECT. The lip is repaired first, at roughly 3 months of age. The classic mnemonic is the 'rule of 10s' — about 10 weeks old, about 10 pounds, and haemoglobin of about 10 g/dL — which identifies an infant large enough and stable enough for safe general anaesthesia. Early lip closure restores the labial muscle ring, improves feeding and appearance, and the reconstituted orbicularis oris exerts a moulding force that narrows the underlying alveolar cleft before the palate is addressed.
• D. 6 to 12 months is the window for PALATE repair, not lip repair. Delaying lip closure this long forfeits the early moulding benefit and the feeding and bonding advantages of an intact lip.

Note: Sequence to memorise: lip at ~3 months → palate at ~9–18 months (before speech) → alveolar bone graft at ~8–11 years (before canine eruption) → orthognathic surgery after growth completes. The palate repair is deliberately delayed relative to the lip because early palatal scarring restricts maxillary growth — the trade-off is always growth versus speech.