<prompt> A four month-old-baby has cleft lip and palate. How would you manage the baby ?Immediate repair of the lipImmediate repair of the lip and palateDelayed repair of the lip and palate until 2 yearsDelayed repair of the lip and palate until preschool age  <response>: .LAHS classification of cleft disorders: L for lip, A for alveolus, H for hard palate, S for soft palate Capital LAHS for complete type Small letters lahs for incomplete type Asterisks lahs for microclefts LAHSHAL for bilateral clefts Treatment for Cleft Lip: Millard criteria is used to undeake surgery for cleft lip Millard criteria Rule of 10 10 pound in weight 10 weeks old 10 gm haemoglobin a. Millard cleft lip repair by rotating the local nasolabial flaps. b. Management of associated primary or secondary cleft palate deformity. c. Proper postoperative management like control of infection, training for sucking, swallowing and speech. d. Tenninsons Z plasty Tenninson-Randall triangular flap. Note: Delaire timing of the cleft surgery - Unilateral bilateral cleft lip alone, in one stage operation done in 4-6 months. For cleft palate alone involving only soft palate, in one stage surgery is done in 6 months. For cleft palate alone but involving both soft and hard palates - soft palate in 6 months; hard palate in 18 months. In combined cleft lip and palate, unilateral or bilateral, in two stages - cleft lip and soft palate in 6 months; hard palate in 18 months. Treatment for Cleft Palate: Criteria for surgery 10 kg weight 10 months of age 10-18 months 10 gm haemoglobin Cleft palate is usually repaired in 12-18 months. Early repair causes retarded maxillary growth probably due to trauma to growth center and periosteum of the maxilla during surgery if done early. Late repair causes speech defect. Both soft and hard palates are repaired. Ref: SRBs Manual of Surgery, 4th Edition, pg. no. 368,372 