Even though facial clefts are one of the most common birth differences in the U.S., parents may struggle to find specialized medical professionals to care for a child with cleft palate or cleft lip and palate. Working closely with young patients and their families, our goal is to repair and restore each child physically, psychologically and socially. We offer facial and dental imaging services and even 3D surgical planning for more complex surgeries.
A cleft palate occurs when the tissues that form the roof of the mouth don’t join together before birth. The opening can be repaired with reconstructive plastic surgery.
The effects of cleft palate run much deeper, causing functional changes in a child’s breathing, hearing, speaking and eating. With our multidisciplinary approach, we provide necessary and related evaluations and therapies, in multiple appointments on the same day. We focus on each child’s total health and well-being with services that also support self-esteem and your child's emotional health.
Specific treatments and services may vary by location. Please contact a specific location for more information.
Surgeons guide families to procedures and surgical approaches to help patients’ physical health, while creating the best possible appearance. Children may require 8 to 9 surgeries to correct the mouth, jaw and nose as they grow into adulthood. Here is an overview of what to expect.
|
Age |
Surgery |
Comments |
|---|---|---|
|
2 - 4 Months |
Cleft Lip Repair |
Ear exams/tubes |
|
6 - 12 Months |
Cleft Palate Repair |
Ear exams/tubes |
|
3 - 6 Years |
Pharyngeal(throat)/Soft Palate Surgery |
Improve speech where necessary |
|
5 - 7 Years |
Cleft Nose Surgery |
If necessary |
|
6 - 9 Years |
Bone (hip) Graft to Gum |
If child does not have enough bone for teeth to come in |
|
18 - 19 Years |
Facial Skeletal Surgery |
If upper jaw does not grow in proper relation to lower jaw |
|
18 - 19 Years |
Further Bone Graft/Dental Implant |
For patients missing teeth at cleft location |
|
14 - 18 Years |
Cleft Rhinoplasty (nose surgery) |
Almost every child will need final corrections after development. Performed earlier in patients not requiring jaw surgery. |
Children born with cleft palate will need to be followed from infancy through their teenage years. Shriners Children’s craniofacial specialists can provide the right care at the right time to give your child the best outcome.
Parents may feel overwhelmed by information but our teams will guide you step by step. Read on to learn more about the cause of cleft palate and what to expect, organized by your child's age.
From our first visit, the hospital staff treated Calvin like royalty, answered all our questions and gave us a comprehensive plan for proceeding with treatment. We love the entire cleft team.
The cleft may be in the baby’s hard or soft palate or both. It may occur by itself or with a cleft lip. It can be unilateral (one side of the palate) or bilateral (both sides of the palate).
Cleft palate can be caused by environmental factors and/or genetics, or as part of a genetic syndrome. It may be diagnosed during routine ultrasounds or be discovered after a baby is born.
A less common type of cleft palate, submucous cleft (often occurs with bifid uvula), may not be diagnosed until later in life. If a child has difficulty feeding and swallowing, chronic ear issues, and air comes through the nose when speaking, our team can provide an evaluation.
The first year of life will involve lots of appointments and one or more surgeries for a baby born with cleft palate or cleft lip/palate. The Shriners Children’s teams work together to combine surgical procedures on the same day to reduce the amount of anesthesia and recovery time for the child.
Parents should receive special instruction on feeding a baby with a cleft palate. Infants with a cleft do not have normal suction in their mouth. Parents may receive special bottles or nipples. Breastfeeding may require supplemental pumped milk or formula. Our speech language pathologists are trained in infant feeding and can provide more information.
If the child also has a cleft lip, the surgeon will repair the cleft lip. We offer DynaCleft taping and nasal elevators for infants. These mold the upper lip and nose before surgery, which helps the surgeon perform a more effective repair. An otolaryngologist may also place ear tubes on the same surgical day.
After surgery, babies wear soft elbow immobilizers to discourage them from touching their face and have a liquid diet.
The cleft palate repair is completed by one year of age, before the child’s first spoken words. At the time of the cleft repair, tubes may be placed in the child’s ears to help reduce ear infections and maximize hearing sensitivity. After surgery, babies may need over-the-counter pain medicine, and will have a liquid, and then a soft food, diet. The stitches in the baby’s mouth will dissolve on their own. Patients see the surgeon and speech therapist one month after surgery.
Babies born with Pierre Robin sequence may need to wait slightly longer for their cleft palate repair to first manage airway issues.
Your child will likely see the full team of specialists once or twice per year. Each child’s speech development is routinely assessed by speech language pathologists.
If speech therapy alone does not help a child speak clearly, pharyngeal/soft palate surgery, typically between 3 and 6 years old, can improve the function of the soft palate which helps the child pronounce words correctly and corrects nasal sounding speech. This surgery involves an overnight hospital stay and your child will eat only soft food during recovery.
School-aged children with cleft palate may notice they look or sound different, even with a repaired cleft. They may also have learning differences related to being born with a cleft. Our teams use a multipronged approach to help. Between ages 5 to 7, any significant differences in the child's larger lip and nose are surgically corrected to minimize psychological effects of a cleft. For all our surgeries, Child life specialists can help children with coping skills, comfort and play, so parents can focus on helping the child heal. Shriners Children’s has child psychologists on the craniofacial team to help with IEPs and support patients with confidence, self-esteem or bullying issues.
Pediatric dental and orthodontic services on Shriners Children's craniofacial teams begin to play a more important role with the development of teeth in early childhood. Bone graft surgery at 8 or 9 replaces missing bone in the gum (the dental arch) for the health of a child’s teeth. This surgery involves an overnight hospital stay. After surgery, patients have only liquids for several days and gradually resume a normal diet.
Almost every child with a cleft will need final corrective surgery after their face develops. Once facial bones are in correct relationship to each other, cleft rhinoplasty (a nose and lip surgery) is performed, typically when the child is between 14 and 19 years old, depending on whether they also need jaw surgery.
While nearly all children who had a cleft will need braces (orthodontia), a smaller number of teenagers will need jaw surgery and orthodontia known as orthognathic surgery or facial skeletal surgery. The surgery in the late teenage years repositions the jaws to improve the child’s bite and appearance. The plastic surgeon carefully plans the surgery with Shriners Children’s dental specialists (dentists, orthodontists and prosthodontists) to achieve the best results.
Terilyn and Evan are siblings both born with cleft lip/palate. Shriners Children's team care provides specialists who will help them grow up to live healthy, normal lives.
Our locations treat thousands of patients with cleft palate every year. Shriners Children’s specialists are very familiar with differences in the facial anatomy of a child born with cleft, including differences in their dental health and hearing.
Children who have a cleft will need unique dental and orthodontic care during different periods of the child’s growth.
Dentistry: Some patients with a cleft or other facial differences may have limited mouth opening so daily teeth care is more difficult. Also, teeth may be missing or appear in the child’s palate. Shriners Children’s team of dentists understands these unique conditions and can coordinate care to provide the best appearance and bite when a child grows up.
Orthodontia: Children with cleft palate usually require a two phase treatment plan. Phase one involves a palate expander before any bone grafts that may be needed in the child’s jaw area. Phase two typically is traditional braces when patients are teenagers. Approximately 25% of children who have cleft lip or palate will require jaw surgery in their late teens to improve their bite and facial proportions.
Children with cleft palate are more likely to have hearing issues caused by fluid buildup inside their ears. Ear tubes may be needed to reduce chronic ear infections which can affect speech and language. Shriners Children’s team care includes evaluation by audiologists and ear, nose and throat surgeons (otolaryngologists). Learn more below about the services for cleft palate provided at Shriners Children’s:
