What is a Cleft Lip?
A cleft lip is a birth defect that may be unilateral or bilateral, complete or incomplete. The goals of cleft lip repair include re-establishment of muscle continuity and re-creation of the normal landmarks of a lip. The skin, muscles, and mucous membranes are surgically repositioned and joined back together. Cleft lip repair is normally performed around 4 to 5 months of age.
Normal landmarks recreated during cleft lip repair include the philtrum (the central dimple of the upper lip), philtrum columns (the ridges on either side of the central dimple), cupid’s bow (the curvature between the white and red regions of the lip), and the vermilion tubercle (the central pout of the upper lip).
What is a Cleft Palate?
A cleft palate occurs when the roof of the mouth doesn’t fully close during development, creating an opening that may affect the soft palate, hard palate, or gumline. Repair is typically done around 10 to 12 months of age to support speech development, and may involve shifting and stitching tissue from the sides to the center. A bone graft may be needed later to support permanent teeth.
Children with cleft palate may face challenges with speech, hearing, and dental development. Many benefit from speech therapy and coordinated surgical care. The Cleft Palate Team includes specialists in plastic surgery, audiology, ENT, dentistry, orthodontics, and oral surgery.
Rady Children’s Health offers expert, long-term care through an accredited cleft and craniofacial program. Our team provides support from infancy through adolescence, ensuring the right treatment at the right time—with the guidance of a dedicated program coordinator.
Complications of Cleft Palate
In addition to visible differences in the lip and/or palate, children with cleft conditions may experience several medical and developmental challenges that benefit from early treatment and a coordinated care plan:
- Feeding challenges: While babies with a cleft lip can often breastfeed or bottle-feed successfully, those with a cleft palate may have difficulty creating suction. Specialized bottles and feeding strategies can help ensure proper nutrition and growth.
- Ear infections and hearing loss: Children with cleft palate are at increased risk for middle ear infections due to fluid buildup. These infections can lead to temporary hearing loss and may require pressure-equalizing tubes to support hearing health.
- Speech and language development: A cleft palate can affect the function of the soft palate muscles, which may impact speech clarity. Early intervention with a speech-language pathologist can help your child develop strong communication skills.
- Dental and orthodontic concerns: Cleft conditions may affect tooth development, spacing, and alignment. Ongoing dental care, and often orthodontic treatment, are essential for long-term oral health. Bone grafting may be needed to support permanent teeth in the gumline.
Palate Repair (Palatoplasty)
Palatoplasty is commonly performed when the child is 10–12 months old. The surgery closes the cleft in layers, repositions soft palate muscles for improved speech, and uses strategic incisions to reduce tension on the repair. It’s done under general anesthesia, with a typical 1–2 day hospital stay. Afterward, the baby follows a liquid diet, transitions to soft foods, and may wear protective sleeves (“no-nos”) to prevent accidental impact to the repair area.
Comprehensive, Team-Based Care
Optimal outcomes come from a coordinated, multidisciplinary approach. Our care team includes surgeons, speech therapists, dentists, audiologists, psychologists, and care coordinators, all working together to support growth, function, and well-being from infancy through adolescence.
What is Maxillary Hypoplasia?
Cleft maxillary hypoplasia is an underdevelopment of the maxilla (upper jaw) occasionally found in children with cleft lip and palate. It is more common in bilateral cleft lip cases.
As the child’s face grows, the upper jaw may not keep pace with the lower jaw’s growth, causing the upper teeth to become abnormally positioned behind the lower teeth. Using principles of orthognathic surgery, the maxilla can be advanced forward, normalizing jaw, lip, and nasal relationships.
Surgical repair of cleft maxillary hypoplasia is typically performed in the teenage years after jaw growth is complete. In severe cases, earlier intervention may be needed to alleviate psychosocial issues. Craniofacial surgeons collaborate with oral surgeons, employing advanced distraction techniques when appropriate.
Before repositioning the upper jaw surgically, orthodontic preparation ensures proper teeth alignment and occlusion. Orthodontic planning and treatment are essential before and after orthognathic surgery.
What is a Cleft Nasal Deformity?
A cleft nasal deformity often occurs alongside cleft lip and palate. It involves widening and flattening on the affected side due to displaced nasal cartilage. The goal of cleft nasal surgery is to restore normal nasal tip projection, align the nostrils, correct the position of the nasal base, and improve breathing by opening the nasal airway. Sometimes, a cartilage graft is necessary. Our surgeons are experienced in advanced nasal surgery techniques and technologies.
In some instances, if the nasal deformity is severe, cleft nasal surgery may be offered between ages 4 to 5, prior to starting school. Most commonly, repair is delayed until the teenage years once the child is done growing.
Children with cleft nasal deformity often experience difficulty breathing through the nose due to nasal septum deviation, which is also corrected during cleft nasal surgery.
Contact Us
If you have questions about cleft lip, cleft palate, or craniofacial care—or want to schedule a consultation—please contact our Cleft and Craniofacial Team below.
Appointments:
858-966-5999, option 5
Location:
7920 Frost Street, Suite 200
San Diego, CA 92123
858-966-5999, option 5
Fax: 858-966-8394