Cleft Lip and Cleft Palate - Care and Treatment

Cleft lip and cleft palate are common birth differences that occur in about one in 600 newborns. They are often diagnosed during a routine fetal ultrasound. Your obstetrician may refer you to our team for a prenatal consultation. You will meet our team coordinator, craniofacial surgeon, craniofacial orthodontist, speech/language pathologist, and social worker. This initial meeting is beneficial as it can reduce anxiety and help you plan for the birth of your baby. During this first meeting, we provide:

• Background on cleft lip and palate
• Information on the standard approach to treating your child’s cleft
• The opportunity to ask questions and discuss all aspects of cleft care
• Education about the types of bottles to use and special strategies to feed your baby after birth

We also offer reassurance and support. Our team is here to help every step of the way.

Immediate Care for Newborns
You and your new baby will have your first team visit within the first week or two after birth. When a cleft lip is present, it is important to evaluate whether nasoalveolar molding (NAM) is appropriate for your baby and start the process early. When a cleft is not diagnosed until after birth -- this may occur in babies with a cleft palate -- we see your newborn as soon as possible. We provide guidance on feeding and begin planning your child’s treatment immediately.

Treating Older Children
We provide ongoing care for children as they grow into their teen years. If kids have been with our team from infancy, we typically see them annually with the entire team to make sure they meet milestones and receive medical and surgical intervention as they grow. Many times, we meet families with older children after they relocate to our area, children who are adopted, or families who wish to gain a second opinion. We fine-tune our treatment approach to fit your child's needs.

The following timeline indicates what procedures may be performed before and after your child’s cleft lip or palate closure. Your child’s treatment plan will be personalized to their needs. The timing of everything is based on cleft type, severity, symmetry, and width. We are your partners in this process and are with you every step.

Ages 1 to 4 Months
The pre-surgical, custom-made orthopedic appliance narrows a wide cleft by bringing together the two sides of the cleft lip and gum while molding the distorted nose. This facilitates the primary lip, nose, and gum surgery, and results in a more aesthetic outcome.

Ages 3 to 6 Months
Cleft lip surgery (cheiloplasty) closes the opening in the lip inside and outside the mouth. At the same time, the surgeon may correct a nasal deformity.

Gingivoperiosteoplasty (GPP) connects the two sides of the gum line to encourage bone growth from one side to the other.  It has been shown to decrease the need for future bone grafting. When possible, this procedure is done at the same time as cleft lip or cleft palate closure. it cannot be done when the gap between the gums is very wide.

Ages 10 to 14 Months
Cleft palate surgery (palatoplasty) closes the opening in the palate. It brings together and aligns the soft tissue on either side of the cleft, as well as the muscles of the palate that are used to produce speech. GPP may be performed at the same time.

Ear tubes are frequently placed during this surgery.

Ages 1 to 2
Speech-language assessments and therapy begin at age 1

Dental checkups begin at age 2.

Ages 4 to 6
Some children may require a second palate surgery. Pharyngoplasty/sphincteroplasty corrects the shape and function of the palate, which can reduce/eliminate nasal speech.  Our speech therapists work with our plastic surgeons to determine whether this procedure will be beneficial.

Ages 6 to 8
Primary orthodontic treatment, including palate expansion.

Ages 7 to 10
Alveolar bone grafting is performed to add bone to the upper jaw. It may be performed in children with a complete cleft lip that involves the gum line. The bone graft is taken from the spongy part on the inside of the hip bone. Harvesting this graft does not affect your child’s ability to walk, run, or play sports.

Ages 10 to 12
Secondary orthodontic treatment (braces)

Ages 17 to 19
Jaw surgery (orthognathic surgery) may be recommended around age 17 to align the upper and lower jaw when orthodontic treatment alone cannot correct the problem. The misalignment can result in problems with speech, chewing, and appearance.

Nose surgery (rhinoplasty) may be performed when your child reaches skeletal maturity to improve function and/or appearance.

Your Child Will be Cared for by an Experienced, Knowledgeable Team
Your child will be evaluated and treated by many specialists including plastic surgeons, craniofacial orthodontists, ear, nose and throat (ENT) specialists, audiology and speech therapy professionals, clinical social workers, and others, as needed. Our cleft and craniofacial team is well-established and one of the oldest in the region. Our experience repairing clefts includes a special focus on your child's ability to speak, feed, and eat successfully.  Our team of specialists provides coordinated, comprehensive care that meets the safety and compliance standards set by the American Cleft Palate-Craniofacial Association.

Our Dedicated Team Coordinator Works Closely with You
Our team is managed by a dedicated team coordinator who ensures that your child’s care is provided in a timely, coordinated, and effective manner. Individualized care is very important to us, so all care is tailored to make your child and family feel comfortable and valued.Your child will typically be seen once a year or in longer intervals to monitor their progress or provide interventions.

We Offer Convenient, Comprehensive Care
Providing convenient, comprehensive care to your child is important. Your child will be seen by each member of the team at every clinic visit, in one convenient location. At the end of the day, our team meets to discuss your child’s progress. This allows us to tailor the treatment plan to meet your child’s individual needs. Our team coordinator then provides you with a summary of the team visit, the team plan, and the next steps.

We Provide Ongoing Support
You will benefit from ongoing support for your emotional, social, and psychological needs. You’ll find a network of support—and friendships—among other families who share similar experiences. You are able to connect through community events and even team visits. In addition, our social worker will educate you about your child’s developmental needs, offer support surrounding the psychosocial implications of having a child with a craniofacial difference, and provide information about financial assistance and other resources available at Duke and in your community.