FIX CLEFT LIP CLEFT PALATE

How Is Cleft Lip & Cleft Palate Repaired?

Cleft lip and cleft palate are among the most common birth defects in the United States, affecting approximately 1 in every 1,600 births. These conditions occur when the tissues that form the lip or the roof of the mouth do not fuse completely during early fetal development, resulting in an opening (cleft) that can affect feeding, speech development, dental alignment, hearing, and facial appearance. Repair typically involves corrective jaw surgery, palatoplasty, and coordinated multidisciplinary care — and the vast majority of children born with a cleft go on to live healthy, fully functional lives.

At Lake Norman Oral & Facial Surgery, Dr. Raymond J. Haigney II — a double board-certified oral and maxillofacial surgeon — works as part of the multidisciplinary team that helps cleft patients achieve optimal outcomes from infancy through adolescence. Below is a comprehensive overview of how cleft lip and cleft palate are diagnosed, treated, and managed over time.

How Cleft Lip & Palate Are Diagnosed

Most cleft lips are visible immediately at birth and require no special diagnostic testing. In many cases, however, the condition is detected well before delivery through routine prenatal imaging.

Prenatal Ultrasound

A standard prenatal ultrasound uses sound waves to create real-time images of the developing fetus. Cleft lip can be identified on ultrasound as early as the 13th week of pregnancy, though detection becomes more reliable as the fetus grows. Cleft palate — particularly an isolated soft palate cleft — is more difficult to visualize on ultrasound and may not be confirmed until after birth.

When a prenatal ultrasound reveals a cleft, the physician may recommend amniocentesis — a procedure that samples amniotic fluid to test for genetic syndromes associated with additional birth defects. In most cases, however, the cause of an isolated cleft lip or palate remains unknown, and the child will have no other associated conditions.

The Multidisciplinary Cleft Team

Treating a cleft is not a single event — it is a coordinated, long-term effort that spans from infancy through the late teen years. Because clefts can affect eating, breathing, speech, hearing, dental development, and facial growth, treatment requires a team of specialists working together. A typical cleft care team includes:

• Oral and maxillofacial surgeons — perform bone grafting, jaw alignment procedures, and secondary surgical corrections as the child grows
• Plastic surgeons or ENTs — perform the initial cleft lip and palate repair surgeries
• Pediatricians — coordinate overall health and development milestones
• Pediatric dentists and orthodontists — manage dental eruption, alignment, and pre-surgical orthodontic preparation
• Speech-language pathologists — address resonance and articulation problems caused by palatal dysfunction
• Audiologists — monitor hearing, as children with cleft palate are at higher risk for recurrent ear infections and fluid buildup
• Genetic counselors — help families understand recurrence risk and any associated syndromes
• Social workers and psychologists — provide emotional support for the child and family throughout the process

Surgical Repair: Cleft Lip

Cleft lip repair (cheiloplasty) is typically performed when the infant is 3 to 6 months old. The surgeon closes the separation in the lip, restores the normal shape of the lip and nose, and aligns the underlying muscle so the lip functions properly for feeding and eventually for speech. Techniques vary depending on the severity of the cleft — unilateral (one-sided) vs. bilateral (both sides) — but all aim to create a symmetrical, natural-looking result with minimal scarring.

Surgical Repair: Cleft Palate (Palatoplasty)

Palatoplasty — the surgical closure of a cleft palate — is generally performed when the child is 10 to 12 months old, before the onset of significant speech development. The goals of palatoplasty are:

• Close the opening between the nasal cavity and the mouth
• Reconstruct the soft palate muscles to create a functioning velopharyngeal mechanism for normal speech
• Prevent food and liquid from passing into the nasal cavity during feeding

During the procedure, the surgeon:

• Closes the cleft in multiple tissue layers (nasal lining, muscle, and oral mucosa)
• Rearranges and repairs the muscles of the soft palate — specifically the levator veli palatini — so they work properly during speech and swallowing
• Makes relaxing incisions on each side of the palate behind the gums to reduce tension on the repair and promote healing

Palatoplasty is performed under general anesthesia and typically takes two to three hours. Most children are discharged from the hospital within one to two days. Dissolvable sutures are used, so no suture removal is needed. A liquid diet is required for the first week or two, followed by soft foods before returning to a normal diet. Parents may be given soft arm splints to prevent the child from placing fingers or objects into the mouth during healing.

Recovery & What to Watch For

While palatoplasty is a highly successful procedure, all surgeries carry some degree of risk. Parents should contact the care team if any of the following occur after surgery:

• Fever above 101.4°F (38.5°C)
• Prolonged or worsening pain that is not controlled with prescribed medication
• Heavy or persistent bleeding from the mouth or nose
• Refusal to drink fluids for more than a few hours
• Decreased wet diapers (a sign of dehydration)

Follow-Up Surgeries & Long-Term Care

The initial lip and palate repairs are just the beginning of a cleft patient's surgical journey. Depending on the severity of the cleft and how the child's face and jaw grow over time, additional procedures may include:

• Alveolar bone grafting — performed around age 7–9, this procedure places bone (usually from the hip) into the gap in the upper jaw to support permanent teeth and stabilize the dental arch
• Secondary palate surgery (pharyngoplasty or pharyngeal flap) — if speech therapy alone does not resolve hypernasality caused by velopharyngeal insufficiency
• Rhinoplasty — to improve nasal symmetry and airway function, typically deferred until the mid-to-late teen years
• Orthognathic (jaw) surgery — if the upper jaw grows deficiently relative to the lower jaw, corrective jaw surgery may be needed after skeletal maturity (age 16–18)
• Orthodontic treatment — spanning multiple phases from mixed dentition through permanent teeth, coordinated with surgical milestones

At Lake Norman Oral & Facial Surgery, Dr. Haigney frequently performs the corrective jaw surgery and bone grafting components of cleft care, working in close coordination with the patient's orthodontist and the broader cleft team.

Long-Term Outlook

With timely intervention and a dedicated care team, children born with cleft lip and cleft palate achieve excellent long-term outcomes. Most reach normal speech, hearing, and dental function. Advances in surgical technique continue to improve cosmetic results, and many patients report high satisfaction with their appearance and quality of life as adults.

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