By William E. Schultz, DVM
For The Education Center
Dentoalveolar cleft and cleft lip are congenital palatal defects resulting from incomplete merging or
fusion of the two palatine shelves that normally unite
in the fetal formation of the face and jaws. 1, 2 Cleft lip is
defined as a fissure involving the upper lip, while the
dentoalveolar cleft is a fissure involving the portion
of the alveolar bone immediately around the teeth. 1
Incomplete palatal closure is attributed to hereditary,
nutritional (folic acid deficiency), hormonal, mechanical or toxic causes. 2
In some neonates, the degree of the cleft defect
is so severe that they are unable to nurse and soon
die. Many neonates with palatal defects develop rhinitis, various respiratory infections and middle ear
disease. 1, 2
The main goal of the surgical repair of palatal defects is to separate the oral and nasal cavities by establishing the nasal floor. Once this is achieved, the
cleft lip may be corrected.
Clifford, a 6-week-old golden retriever, was admit-
ted with a unilateral cleft lip and dentoalveolar cleft
with premaxillary deformity. The cleft extended into
the right nares with the nares open dorsally. Tooth 502
was missing, and the left rostral premaxilla and soft
tissue were skewed cranially (Figures 1 and 2).
The owner brought the dog in with the complaint
of nasal congestion after meal intake. We decided to
not delay the surgery in order to avoid the potential
development of a bacterial rhinitis (secondary to food
passing into the nasal cavity through the defect).
Physical examination showed that Clifford had a
sufficient amount of tissue to repair his defects. The
availability of the CO2 laser allowed the surgery to be
performed on such a young patient.
n 4020 flexible fiber waveguide Aesculight CO2 la-
ser with tipless adjustable spot size hand piece. (Hand
piece is shown in Figures 4, 5, 6, 8 and 9.)
n Small osteotome (Figure 3).
n Stainless steel wire and 20-gauge needle.
Power: 6 W
Laser mode: SuperPulse
Spot size: 0.25 mm
The patient’s pre-anesthetic physical exam and blood
test results were normal. He was pre-anesthetized with
atropine, acepromazine and torbutrol. General anes-
thesia was induced with propofol and maintained on
sevoflurane. The endotracheal tube was wrapped in sa-
line-soaked gauze to prevent inadvertent laser puncture.
The premaxilla was elevated with an osteotome (
Figure 3). Gingiva was incised to gain access to the bone
(Figures 4 and 5). The caudal aspect of the elevated premaxilla was trimmed with the laser to allow the teeth to
be parallel with the mandibular incisors (Figure 6).
The 4020 Aesculight laser model is capable of producing 100 watts of peak SuperPulse power. In combination with the elevated water content in the young
growing bone, this allowed for accurate char-free ablation and cutting. After trimming was completed, the
bone was wiped with saline-soaked gauze. Then the
premaxilla and deciduous teeth were reattached with
stainless wire using a 20-gauge needle as a manual drill
The laser was then used to freshen the edges of the
nares and the upper lip (Figures 8 and 9). The gingival
mucosa was cut to allow the left upper lip to move to the
right, thus filling in the defect. Closure was completed
using 3-0 Monocryl sutures in an interrupted pattern.
Learn to use CO2 laser for
repair of oral-facial clefts
1. Merretta SM. Cleft palate repair techniques. In: Verstraete FJM,
Lommer MJ, eds. Oral and maxillofacial surgery in dogs and cats.
Edinburgh: Saunders Elsevier, 2012:351-61.
2. Hedlund CS, Fossum TW. Surgery of the digestive system. In: Fossum
TW, ed. Small animal surgery, 3rd ed, St. Louis, MO: Elseveir/Mosby,
Figure 7. The bone was checked for placement of the stainless wire suture.
Figure 4. Laser resection of the gingiva allowed access to the
premaxilla prior to trimming the margins.
Figure 1. Pre-operative view
Figure 8. The dorsal aspect of the nares deformity was freshened.
Figure 5. Laser resection of the gingiva was made access to the cau-
dal aspect of the premaxilla.
Figure 2. Ventral pre-operative view
Figure 9. The medial aspect of the deformity was freshened.
Figure 6. Excess bone was trimmed from the caudal aspect of the
premaxilla to allow for normal placement of the incisors.
Figure 3. The osteotome was used to elevate the deformed premaxilla.