Cleft Lip and Palate Treatment Timeline

The following timeline outlines the procedures that may be performed during your child's cleft journey. We consider your child's cleft type, severity, symmetry, and width when personalizing the timing of these procedures, appointments, and surgeries.. We are your partners in this process.

Ages 1 to 4 Months
Nasoalveolar Molding (NAM) may be recommended for infants born with a cleft lip. The custom-made orthopedic appliance narrows a wide cleft by bringing together the two sides of the cleft lip and gum while molding the asymmetric 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. The surgeon may correct a nasal asymmetry at the same time.

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 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 around age 1.

Routine dental check-ups begin at age 2.

Ages 4 to 6
Because of the individual structures, some children may require palate revision 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 or if hypernasal speech can be corrected with specialized speech therapy.

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

Ages 7 to 10
Alveolar bone grafting can add bone to the upper jaw. It may be performed in children with a complete cleft lip that involves the gum line. Children who have undergone NAM and GPP may not require an alveolar bone graft. 

A specialized 3D CT scan is taken in the craniofacial orthodontic office to see if there is sufficient bone in the gum line to support the upper teeth. If not, the craniofacial orthodontist and the pediatric plastic surgeon work together to complete the procedure. 

The bone graft is taken from the spongy part on the inside of the hip bone. While initially sore, taking this graft from the hip won’t affect your child’s ability to walk, run, or play sports in the long term.

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 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.