During cleft lip surgery, the skin, muscle and lining are put in the proper place. The nose is also treated at the time of the first surgery, but often needs some minor surgeries as the child grows.
During cleft palate surgery, the muscles at the back of the palate need to be put in their proper place across the cleft so the child can learn to speak normally.
Bilateral cleft lip repair
(Left) The skin needed to do the repair is present, but not in the right place or shape.
(Center) Surgery puts the skin, muscle and cartilage back in the correct position.
(Right) After 1 year, the lip and nose have relaxed in the new position. The scars are visible as white lines.
The medical care for a child with a cleft requires a complex, lengthy treatment plan lasting until adulthood (see table below).
The goal of our cleft team is to minimize the number of steps in the treatment plan by improving the outcome of each step.
Cleft Lip and Palate Treatment Options
All members of the craniofacial team may need to be involved in the care of a child with a cleft at different times. This table lists the key interventions for treatment by age. An intervention is what is checked and what is done based on the findings.
Key Interventions by Age* | Age | Intervention |
|---|
| * This table does not contain every intervention that may be needed by a particular child at a certain age. |
| Prenatal | - Referred to cleft lip and palate team
- Diagnosis and genetic counseling
- Address psychosocial issues
- Provide feeding instructions
- Make feeding plan
|
| Birth-1 month | - Referred to cleft lip and palate team
- Diagnosis and genetic counseling
- Address psychosocial issues
- Provide feeding instructions and check growth
|
| 1-4 months | - Check feeding and growth
- Repair cleft lip
- Check ears and hearing
|
| 5-15 months | - Check feeding, growth, development
- Check ears and hearing; consider ear tubes
- Repair cleft palate
- Provide oral hygiene instructions
|
| 16-24 months | - Assess ears and hearing
- Assess speech and language
- Check development
|
| 2-5 years | - Assess speech and language; manage velopharyngeal insufficiency
- Check ears and hearing
- Consider lip/nose revision before school
- Assess development and psychosocial adjustment
|
| 6-11 years | - Assess speech and language; manage velopharyngeal insufficiency
- Orthodontic interventions
- Alveolar bone graft
- Assess school/psychosocial adjustment
|
| 12-21 years | - Jaw surgery, rhinoplasty as needed
- Orthodontic bridges, implants as needed
- Genetic counseling
- Assess school/psychosocial adjustment
|
New Treatments for Cleft Lip and Palate
Recent advances in presurgical orthopedics, such as nasoalveolar molding and gingivoperiosteoplasty (a procedure to close a cleft in the gum), are early interventions that reduce the need for surgeries as the child grows up.