Cleft Lip and Cleft Palate | Diagnosis & Treatments

The first step in treating your child is forming an accurate and complete diagnosis.

How is cleft lip/cleft palate diagnosed?

In most cases, a prenatal ultrasound can detect cleft lip alone or cleft lip and palate as early as 16 weeks into a pregnancy. The diagnosis is then confirmed at birth with a detailed visual assessment and physical examination. In some cases of incomplete cleft lip, the diagnosis cannot be seen on ultrasound and is made for the first time at birth.

Cleft palate can occur alone, without cleft lip. This type of cleft may not show up on ultrasound and may be diagnosed for the first time at birth. At that point, a clinician will perform a comprehensive exam to identify the exact nature of the problem and determine whether the cleft involves the hard and soft palate, or the soft palate only. In a small number of cases, cleft palate is diagnosed on a fetal MRI performed for other reasons, such as a small lower jaw. Infrequently, a minor case of cleft soft palate will not even be seen at birth and will become noticeable later when the infant experiences difficulty feeding.

How we treat cleft lip and cleft palate

Treatment for a cleft lip/cleft palate usually involves reconstructive surgery and several key support services.

The Cleft Lip and Palate Program at Boston Children’s Hospital takes a multidisciplinary team approach to repairing your child's specific cleft and addressing related conditions.

While your child's treatment plan will depend on their individual circumstances — as well as your family's preferences — here are some frequently asked questions about treating cleft lip/cleft palate:

Surgical repair: Cleft lip

When are presurgical orthopedics considered?

Many children with a unilateral complete cleft lip and palate have a large gap between their gums. To move the gums and palate into a closer position, presurgical orthopedics are often recommended. In most cases, this is a Latham-type appliance. A dentist inserts this device in the operating room when a child is around 2 or 3 months old. You will need to turn a small screw on the device to slowly bring the gums together. The device is removed at the time of either lip-nasal adhesion or complete cleft lip repair.

For some children with unilateral cleft lip who have more severe nasal asymmetry, nasal molding may be recommended. A DynaCleft® nasal elevator is an external device that may be started at the first clinic visit. This device slowly rounds and elevates the nasal cartilage to improve nasal shape and can be used with or without a Latham-type appliance.

What is a “lip-nasal adhesion” procedure?

For some children with a unilateral cleft lip, the first operation recommended is a lip-nasal adhesion. This operation is performed at about 3 months of age, and involves:

  • simple closure of the lip
  • the first stage of nasal correction
  • when possible, closure of the cleft in the upper gum (this procedure is called gingivoperiosteoplasty)

How and when is a cleft lip typically repaired?

When a single operation is recommended, either for unilateral or bilateral cleft lip, it typically occurs when the child is between 3 and 5 months of age. During this operation, the baby's nasal asymmetry (unevenness in the shape of the nose) is also corrected. A plastic surgeon uses the existing muscle and tissues of your child's lip and nose to close the cleft. Repair of a unilateral cleft lip is performed in the operating room under general anesthesia. Your child will stay in the hospital for one to two nights after the operation.

In children for whom two operations are recommended, the first is lip-nasal adhesion. The second operation is a more comprehensive repair of the cleft lip and correction of the nose. This procedure usually takes place around three months later, at 5 to 6 months of age.

How will my child look after the cleft lip is repaired?

After the operation, your child's lip, nose, and face will be swollen for a few days. The scar may be red for several months. It will take 6 to 12 months for the scar to soften and fade.

Although it will never completely disappear, in time, the scar will become difficult to see. Your child's lip and nose will be nearly normal in appearance after the swelling and scar have subsided.

Unilateral complete cleft lip and palate before repair (left) and after nasal molding with DynaCleft, alveolar correction with a Latham appliance, single-stage cleft lip repair, and cleft palate repair.

Unilateral complete cleft lip and palate before repair (left) and after nasal molding with DynaCleft, alveolar correction with a Latham appliance, single-stage cleft lip repair, and cleft palate repair.

As my child gets older, will another operation be necessary?

Although some children need to have another procedure on their lips and/or nose before they begin school, or as they enter adolescence, other children never need further surgery.

Children whose cleft lips involve the alveolus, or gum line, typically need another operation to help their permanent teeth come in and to make it easier for orthodontic treatments to improve their bite and jaw function. This operation is called an alveolar bone graft, and is usually performed when the child is 8 to 10 years old.

Surgical repair: Cleft palate

How is a cleft palate usually repaired?

A plastic surgeon brings together the separated muscles and tissue from the two halves of the palate to close the opening. This procedure is performed in the operating room under general anesthesia. Your child will be in the hospital anywhere from one to three nights after the operation.

When will my child's cleft palate be repaired?

A cleft palate is typically closed between the ages of 9 and 11 months, before a baby makes their first attempt to use words. Your child's plastic surgeon will discuss the best repair plan for their needs and circumstances.

What precautions do I need to take after my child's cleft palate repair?

Immediately after surgery, you should give your child liquid foods, such as stage 1 baby food, using the side of a soft-tipped baby spoon. After around 10 days, your child will be able to have soft foods, such as stage 3 baby foods or soft cut up fruit. Your surgeon may ask you to rinse your child's mouth with water for the first 10 to 14 days after surgery to help keep the stitches clean.

Will my child experience any side effects after the surgical repair?

Your child may regurgitate some food and liquid through their nose for up to three months after the operation. This is normal. It takes time for the swelling to go away and for the muscles in the palate to begin working properly. You'll be given further post-operative instructions when your child is discharged.

As my child gets older, will another operation be necessary?

Approximately 5 to 15 percent of all children who have undergone a cleft palate repair will need a second operation to correct “nasal”-sounding speech. These operations are often performed around 4 to 6 years old. A common procedure is called a pharyngeal flap, but other operations may be recommended based on your child’s anatomy.

Long-term monitoring and follow-up

The follow-up care your child will need depends on the extent of his cleft lip and/or cleft palate. In our Cleft Lip and Palate Program, we see patients as frequently as every six months to every other year, from infancy all the way through adolescence.

Your treatment team will develop a follow-up schedule that works best for you, your child, and your family.