Chromosomal and Genetic Conditions

Cleft Lip and Cleft Palate Treatment

Cleft Lip and Palate Surgery

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.

The medical care for a child with a cleft requires a complex, lengthy treatment plan lasting until adulthood.

The goal of our cleft team is to minimize the number of steps in the treatment plan by improving the outcome of each step.

Before-and-after pictures

Bilateral cleft lip repair

Bilateral cleft lip repair

  • Before (left): The skin needed to do the repair is present, but not in the right place or shape.
  • During (center): Surgery puts the skin, muscle and cartilage back in the correct position.
  • After (right): After 1 year, the lip and nose have relaxed in the new position. The scars are visible as white lines.


Kindergarten rhinoplasty (nose surgery)

During kindergarten rhinoplasty for bilateral cleft lip, the nostrils are brought together so they are round, not flat.



  • Before (left): In children with bilateral cleft lip, there's often a small amount of fat between the cartilage separating the left and right nostril. This prevents the nostrils from growing forward together. Instead they grow out to the sides, making the nose wide and flat. This is a main challenge of treating bilateral cleft lip.
  • During (center): Most surgeons wait to correct the nostrils until a patient is in their teens. But by then the skin can be stiff, and the nose shape can be hard to change. At Seattle Children's, we do a day surgery around age 5 to bring the nostrils together so they are round, not flat. The surgery takes about 45 minutes.
  • After (right): After surgery the nose grows forward, so it looks more typical, and breathing is easier. Many children who have this surgery do not need nasal surgery again in their teens (after their nose grows more). If they do need surgery again, they may get better results because their nostrils were moved when they were younger.


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

This table does not contain every intervention that may be needed by a particular child at a certain age.

Age Intervention
  • 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 (such as kindergarten rhinoplasty) 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 (nose surgery) as needed
  • Orthodontic bridges, implants as needed
  • Genetic counseling
  • Assess school/psychosocial adjustment

New Treatments for Cleft Lip and Palate

Recent advances in pre-surgical orthopedics, such as nasoalveolar molding (NAM) 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. Members of Seattle Children’s craniofacial team designed and patented the Seattle alar molding (SAM) device, which can be used with or without NAM, to improve the symmetry of your child’s nose before surgery.

Learn about research at Seattle Children's into cleft lip and palate.