Cleft lip and palate - Treating cleft lip and palate

Cleft lip and palate is usually treated with surgery. Other treatments may be needed to treat associated symptoms, such as speech therapy or dental care.

In this section, the term cleft refers to a cleft lip, cleft palate, or a cleft lip and palate. Specific types of cleft are only referred to when necessary.

Cleft clinics and treatment teams

In England, all children born with a cleft are referred to a specialist multi-disciplinary cleft team within a specialist centre.

The cleft treatment team is made up of healthcare professionals from different specialist backgrounds who work closely together. The team includes:

a specialist cleft nurse, who will provide initial advice about feeding and act as your first point of contact
a cleft surgeon, who will carry out the repair of the cleft
a paediatrician, a doctor who specialises in treating children
an audiologist and an ear, nose and throat (ENT) surgeon, who will both assess and treat hearing conditions
a speech and language therapist, who will assess and treat speech problems
a paediatric (children's) dentist, who will help prevent dental decay
an orthodontist, who specialises in dental and jaw development
a psychologist

The core members of the team will be available at the outpatient cleft clinic appointments to give you advice and answer any questions you may have.

Care plan timetable

Most children with clefts will receive the same type of care plan tailored to meet their individual needs. A typical care plan timetable for cleft lip and palate is described below:

following birth to six weeks: feeding assistance, support for parents, hearing test and paediatric assessment
three months: surgery to repair a cleft lip
six to 12 months: surgery to repair a cleft palate
18 months: speech assessment
three years: speech assessment
five years: speech assessment
eight to 11 years: bone graft to the cleft in the gum area (alveolus)
11-15 years: orthodontic treatment and monitoring jaw growth

Once the initial care plan has been completed, your child will attend regular outpatient appointments at the cleft clinic so their condition can be monitored closely and any problems can be dealt with.

Important records are taken at key stages of development at age five, 10, 15 and 20 years to monitor how treatment has progressed over time.

Feeding

If your baby has a cleft, their feeding will need to be assessed so any problems can be resolved. Many babies with a cleft palate have problems breastfeeding due to the gap in the roof of their mouth.

If your baby has difficulty feeding, your specialist cleft nurse can advise on alternative feeding methods. Some babies respond better to alternative feeding methods than others.

One method that works well for some women is expressing breast milk and using a specially made flexible bottle for feeding.

Lip repair surgery

All types of surgery required for cleft lip and palate are available on the NHS. There are nine centres in England and Wales and further specialist centres in Scotland and Northern Ireland.

Lip repair surgery is usually carried out when your child is three months old. Your child will be given a general anaesthetic (where they are asleep) and the cleft lip carefully repaired, including underlying muscles. The nose is usually reshaped at the same time.

The operation usually takes between one and two hours, although it can take longer if the cleft is more extensive. The surgery leaves a slight scar, but the surgeon will attempt to line up the scar with the natural lines of the lip to make it less noticeable.

Palate repair surgery

Palate repair surgery is usually carried out when your child is six to 12 months old. The muscles and the lining of the palate are rearranged and usually no extra tissue is needed to complete the operation.

The operation usually takes about two hours and is carried out under general anaesthetic.

Additional surgery

In some cases, additional surgery may be needed to improve the appearance and function of the lips and palate. Although the palate works well during speech for most children after surgery, in a small number of cases further surgery may be necessary. This may be necessary if the palate is not working sufficiently well for normal speech or if a hole has opened up in the palate during the early stage of healing.

Also, if there is a cleft in the gum (alveolus), the surgeon will perform a bone graft operation to repair the alveolar cleft, usually when the child is around nine to 12 years old.

In some young adults, surgery can be considered if the growth of the jaws are not equal.

Treating associated symptoms

Hearing

Children with a cleft palate are more likely to develop a condition called glue ear. This is because the muscles in the palate are connected to the middle ear. Because the muscles are not working properly due to the cleft, sticky secretions may build up within the middle ear which may reduce hearing. The condition may improve after cleft palate repair and if necessary, can be treated.

If hearing is significantly reduced, the ENT surgeon may recommend inserting a tiny plastic tube called a grommet into the eardrum. This lets out the sticky secretions and allows air in. Sometimes, a hearing aid may be recommended.

An audiologist (hearing specialist) will assess your child's hearing at birth and a second hearing assessment will take place once your child has had reconstructive surgery. Your child's hearing will also be regularly assessed during the first few years.

Speech and language therapy

Repairing a cleft palate will significantly reduce the chance of future speech problems. However, approximately half of all children with a repaired cleft palate still need some form of speech therapy. Further corrective surgery may be required for a small number of children who have increased airflow through their nose when they're speaking.

A speech and language therapist (SLT) will carry out an initial assessment after surgery, followed by a further assessment once your child is three years old. If the assessment reveals problems with your child's pronunciation and use of language, the SLT will teach you speech exercises to help your child's development. They may also carry out a number of one-to-one exercises with your child. Children born with cleft lip only do not normally need further therapy.

The SLT will work with your child for as long as they need assistance. Therapy is not usually needed after the age of seven.

Watch a video on speech and language therapy.

Dental care

When the cleft involves the gum area, it's common for teeth on either side of the cleft to be tilted or out of position. Often a tooth may be missing, or there may be an extra tooth. The paediatric dentist will monitor the health of your child's teeth and recommend treatment when necessary. It's also important that you register your child with a family dentist.

Orthodontic treatment, which helps improve the alignment and appearance of teeth, may also be required. Treatment can include using braces or other dental appliances to help straighten the teeth. Orthodontic treatment will also monitor the development of the jaws and the bite during growth.

Children with a cleft are more vulnerable to tooth decay, so it's important to encourage them to practise good oral hygiene.

Read more about complications of cleft lip and palate.