Cleft Lip and Cleft Palate Surgery

If your child has a diagnosis of a cleft lip, cleft palate or both, we're here for you.

Our nationally recognized experts oversee care from your child's birth into adulthood. Our doctors have spent decades conducting research, writing textbooks and advising Smile Train, one of the world's biggest cleft charities.

We put this special expertise to work on behalf of your child. You'll notice it in the details, including treatment plans that address all of your child's medical and developmental needs. We also use surgical techniques that lead to more natural-looking results.

You probably have lots of questions if your child has cleft lip, cleft palate or both. We can help. If you would like to schedule an appointment or speak to our staff, please call us at 682-885-7770.

What are cleft lip and cleft palate?

A cleft lip and cleft palate are related conditions that can occur together or happen on their own:

A cleft lip is an opening in the upper lip, usually just below the nose.
A cleft palate is:
An opening in the roof of the mouth (hard palate)
Or an opening in the soft tissue at the back of the mouth (soft palate)

Early in pregnancy, all babies have openings in the lip and palate. The openings should gradually come together as babies develop in the womb, eventually closing before birth. In children with clefts, these openings don't close. A baby may have inherited a genetic change or been affected by the birth parent's smoking or drinking during pregnancy, for example.

Cleft lip and palate are among the most common congenital conditions - health issues present at birth. Doctors fix cleft lips and palates with surgery. However, your child may need other treatments to address issues related to these conditions.

Learn more about the causes and diagnosis of:

Choosing Cook Children's for cleft lip and cleft palate care

Our craniofacial surgeons have decades of experience delivering great outcomes to children like yours. They bring together all the expertise needed to provide a true team approach. While most cleft centers are at teaching medical centers, ours is not. Your child remains in expert hands at all times.

With our program, you can expect:

Recognition from the American Cleft Palate Craniofacial Association, which sets the standards for the range of cleft expertise teams should provide (learn more about our Pediatric Plastic Surgery team)
Board certified, fellowship-trained craniofacial surgeons who remain directly involved in your child's care each step of the way
Long-lasting relationships, with care often lasting into adulthood. You become like family to us, and we remain your trusted partner and guide for cleft help.
Personalized care that addresses other difficulties related to cleft lip and palate, including social and emotional concerns
Easy access to our cleft team coordinator to get questions answered and help you make and manage appointments. We try to schedule visits with multiple specialists on the same day so you can travel less and have more time for what matters.
Parent education and child-friendly explanations so your family always knows what to expect and how to cope and recover

Cleft lip and palate treatment timeline

At Cook Children's, we see most babies with a cleft soon after birth. We recommend a treatment plan for your baby during initial visits. We then follow up with you closely for any needed care and to discuss any questions or concerns.

The number and types of surgeries your child needs depend on whether they have a cleft palate, cleft lip or both. We usually repair cleft palates when babies are around 9 to 12 months old. To repair a cleft lip, children usually have surgery when they are 3 to 6 months old.

Children with a bilateral cleft lip (both sides have a split) may need two surgeries. Your surgeon recommends the best timing based on your child's particular needs.

Cleft lip and palate care is individualized. Your child may need additional care, support or surgeries as they grow and change. Our program helps you manage it all - from feeding your child to preparing them for the questions and reactions they'll likely experience later as they grow up.

Prenatal visits give your child a head start

We work with our Fetal Center to get a head start on your baby's care If a prenatal ultrasound reveals a cleft lip or palate. During in-person or virtual visits, we talk with you about what to expect and lay the groundwork for successful treatment.

We also help make sure you have what you need if you plan to deliver your baby far from our team. For example, we can help you get special baby bottles that may not be available in your area.

After the initial visit, you'll have the knowledge to care for your baby the moment they arrive. You'll also have direct access and support from our whole team.

Presurgical molding sets the stage for success

Sometimes cleft lip and palate repair involves gently reshaping facial tissues, such as the nose or lips, before surgery. The goal is to prepare these tissues so we can more easily handle and repair them. Getting your child's appearance as balanced as possible before surgery gives them a better chance for a more natural appearance later.

This preparation, called presurgical molding or presurgical orthodontics, is not surgery. Parents help with the process, which may involve:

Lip taping: We use surgical tape to shorten the distance between the two lip segments. Lip taping helps us gently stretch and reposition these tissues before surgery. It helps improve your child's appearance and lip function afterward.
Nasal elevation: With a small hook, we gently lift the affected nostril and gradually move it to match the height of the other one. The positioning creates a more balanced nose shape before surgery and can help your child avoid later nose surgeries.

Presurgical molding involves taking steps at home. Our team helps guide you throughout the process.

Cleft lip and cleft palate repair surgery

We seek to restore as much of your child's appearance as possible. While your child will have scars from surgery, these will fade over time because of the advanced techniques involved.

To start, your child will receive sedation or anesthesia and be asleep during cleft lip or cleft palate surgery. While both surgeries involve intricate repairs, the basic steps include:

Cleft lip repair: Your surgeon carefully makes incisions on either side of the cleft to create natural flaps. They then connect the muscle of the lip and pull the flaps together with stitches. They finish by shaping the nose with stitches.
Cleft palate repair: Your child's plastic surgeon creates natural flaps, which allows them to rebuild the palate's tissue, bone and muscle. They close the flap with stitches.

After surgery, your child may need a short medical center stay. You may also need to take precautions at home to protect the surgical area and help your child heal. Your surgeon will discuss recovery with you so you know what to expect.

Other medical issues and treatments related to cleft lip and palate

A cleft lip and palate can lead to other difficulties, including:

Feeding issues

A child with a cleft palate can have difficulty breastfeeding or sucking through a regular bottle nipple. The gap in the roof of their mouth causes this issue. Most babies require a modified or specialized bottle nipple to feed properly.

During your first visit with us, you meet with a feeding specialist to determine the best way to feed your baby. This meeting helps ensure your baby puts on weight and thrives.

If your baby is diagnosed in the womb, our feeding specialist will contact you to provide resources and review what to expect for feeding.

You also have access to our pediatric gastroenterologists to manage any digestive issues that may arise. Learn more about Gastroenterology and Feeding Therapy at Cook Children's.

Speech issues

Children with an unrepaired cleft palate have a nasal quality to their speech. This voice pattern happens because air escapes through the gap in the roof of the mouth and out the nose.

After cleft palate repair, most children develop near-typical speech. Our Speech Therapy team, which includes bilingual therapists, can also help children improve their speech. Your doctor helps you determine if your child needs this type of therapy.

Ear infections and hearing issues

Children with a cleft palate are at risk of developing frequent ear infections because of fluid buildup in the middle ear. Repeated ear infections can cause eardrum scarring, which can affect hearing.

To address this problem, we can insert ear tubes during cleft lip and palate repair surgery. The ear tubes help drain the middle ear and reduce the risk of future ear infections. Learn more about our integrated Ear, Nose and Throat services.

Dental issues

Children with a cleft palate or a cleft through the gumline can have dental issues. Teeth (either baby or permanent) may be missing, crooked or unusually shaped. Also, the upper jaw may not grow as far forward as the lower jaw. This problem could require corrective surgery later in life.

Your cleft team works with Cook Children's dental specialists, including pediatric dentists and orthodontists, to treat these problems successfully.

Long-term cleft repair follow-up

Given how the body changes as it grows, children with cleft repairs need regular medical checkups - even if everything seems fine.

During annual follow-up visits, we bring together the specialists your child may need to ensure they stay on track. We check their:

Appearance
Speech
Social and behavioral development

We continue to provide any support your family needs. Services include working with social workers and caseworkers to address ongoing care challenges.