Newborn Craniofacial Surgery

An orofacial (or-oh-FAY-shul) cleft is when a baby is born with an opening in the lip and/or roof of the mouth (palate). Cleft lip and cleft palate happen in about 1 or 2 of every 1,000 babies born in the United States each year, making it one of the most common birth defects.

Both cleft lip and cleft palate are treatable. Most kids can have surgery to repair them within the first year or two of life.

How a cleft lip or palate forms

During the first 6 to 10 weeks of pregnancy, the bones and tissues of a baby's upper jaw, nose, and mouth normally come together (fuse) to form the roof of the mouth and the upper lip. A cleft happens when parts of the lip and mouth do not completely fuse together.

A cleft lip may just look like a small opening on the edge of the lip, or it could extend into the nose. It may also extend into the gums. A cleft palate can vary in size. It could affect just the soft palate, which is near the back of the throat, or it also could make a hole in the hard palate toward the front of the mouth.

A cleft can be on one side of the mouth (unilateral clefting) or on both sides of the mouth (bilateral clefting). Most clefts fit into one of three categories:

Cleft lip by itself – most common in boys
Cleft palate by itself – most common in girls
Cleft lip and cleft palate together – more common in boys

Usually, cleft lip is found when a baby is born, although some are seen on a prenatal ultrasound. A cleft palate is more difficult to see until the inside of a child's mouth is examined carefully after birth.

Surgical treatment

A cleft lip is usually surgically repaired in the hospital using general anesthesia when a child is 3 to 6 months old. If the cleft lip is wide, special procedures like lip adhesion or a molding plate device might help bring the parts of the lip closer together before the lip is fully repaired. Cleft lip repair usually leaves a small scar on the lip under the nose.

At 9-12 months of age, a cleft palate usually can be repaired. Plastic surgeons connect the muscles of the soft palate and rearrange the tissues to close the cleft. This surgery requires general anesthesia and a short hospital stay for recovery.

The goal of surgery is to create a palate that works well for speech. Some kids, however, will continue to sound nasal after cleft palate repair, and some may develop a nasal voice later on.

More surgeries may be needed as children grow older and their facial structure changes—this can include surgeries like pharyngoplasty, which helps improve speech, or alveolar bone grafts, which help provide stability for permanent teeth. A bone graft closes gaps in the bone or gums near the front teeth and is usually done when kids are between 6 and 10 years old.

Learn more about our craniofacial program

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If you are interested in scheduling a tour of our NICU, please call 682-885-4375. You can find information on how to refer a patient or other NICU contact information here.