Reversed Sequence of Cleft Repair: Palate First, Lip Second in Bilateral Cleft with Severely Protruded Premaxilla and Delayed Presentation

The conventional protocol for cleft lip and palate repair prioritizes cleft lip correction followed by palatoplasty. This sequence optimizes aesthetic outcomes, orofacial function, and developmental milestones, including feeding, speech articulation, and maxillofacial growth. However, reversing this sequence-performing palatoplasty before cheiloplasty-may confer distinct advantages in severe bilateral cleft lip and palate with a markedly protruded premaxilla or in cases with delayed presentations. Early palate repair can facilitate the realignment of alveolar segments, stabilize the palatal arch, and establish a more robust foundation for subsequent lip repair. In delayed presentations, early palatoplasty may enhance speech development and reduce the incidence of otitis media before lip repair.