What Is Cleft Lip and Palate?
A cleft lip is a separation in the upper lip. A cleft palate is an opening in the roof of the mouth. Both happen before birth when tissues do not fully join.
A cleft can affect the lip alone, the palate alone, or both together. It can be on one side (unilateral) or both sides (bilateral). Some clefts are small notches. Others extend through the lip, gum, and palate.
Clefts are among the most common birth differences worldwide. In the United States, cleft lip with or without cleft palate occurs in about 1 in 1,600 live births. Cleft palate alone occurs in about 1 in 1,700 births. Rates differ by ancestry and region.[1]
Children with clefts may have trouble feeding, speaking, hearing, and with dental development. With timely surgery and team-based care, most children grow up with normal function and appearance.[2]
Causes and Risk Factors
Clefts form when facial tissues do not fully fuse during early pregnancy. Both genetic and environmental factors play a role, and the exact cause is often unclear.
Genetic Factors
A family history of cleft lip or palate raises a child's risk. In many cases, no single gene is responsible. Multiple genes interact with environmental factors.
Some clefts occur as part of a genetic syndrome. Examples include Van der Woude syndrome, 22q11.2 deletion syndrome, and Pierre Robin sequence. About 30 percent of cleft cases are linked to a known syndrome.
Environmental Factors
Several exposures during early pregnancy can raise the risk of a cleft. These include smoking, heavy alcohol use, certain seizure medications, and some acne medications.
Low folic acid intake before and during early pregnancy is also linked to higher risk. Diabetes during pregnancy may increase risk as well. Prenatal care that addresses these factors can reduce, but not eliminate, the chance of a cleft.
Symptoms and Diagnosis
Cleft lip is visible at birth or on prenatal ultrasound. Cleft palate may be found during the first newborn exam or when feeding problems appear.
Common Symptoms
Beyond the visible split in the lip or palate, families often notice other signs in the first weeks of life:
- Trouble forming a seal during breast or bottle feeding
- Milk coming out through the nose
- Slow weight gain
- Frequent ear infections from fluid buildup
- Nasal-sounding voice as the child begins to speak
- Delayed eruption of baby teeth or missing teeth near the cleft
How It Is Diagnosed
Cleft lip can often be seen on a prenatal ultrasound at 18 to 22 weeks. Cleft palate alone is harder to see before birth and is usually diagnosed at delivery.
After birth, the pediatrician examines the lip, gums, and palate. A submucous cleft, where the muscle is split but the surface looks intact, may not be found until speech delays or feeding issues appear. Imaging and genetic testing may follow if a syndrome is suspected.[2]
Treatment Options
Treatment follows a staged timeline from infancy through adolescence. A cleft team plans each step around the child's growth and development.
Presurgical Care and Feeding Support
Specialized bottles and nipples help babies feed before surgery. A feeding specialist often guides families in the first weeks.
For wider clefts, nasoalveolar molding (NAM) may be used. A custom oral appliance gradually shapes the gum and nose tissues. NAM can reduce the size of the cleft and improve surgical results, though it adds clinic visits in the first months of life.
Cleft Lip Repair (Cheiloplasty)
Lip repair is typically done between 3 and 6 months of age. The surgeon closes the lip in layers, repositions the muscle, and reshapes the nostril.[1]
Most children spend one to two nights in the hospital. The visible scar fades over the first year. Some children need a lip revision later for symmetry or scar appearance.
Cleft Palate Repair (Palatoplasty)
Palate repair is usually done between 9 and 18 months. Closing the palate before major speech development supports normal speech patterns.
The surgeon rebuilds the muscle layer and closes the soft and hard palate. Hospital stay is typically two to three nights. A follow-up procedure may be needed if speech remains nasal or if a small opening (fistula) forms.
Alveolar Bone Grafting
Children with a cleft through the gum line need a bone graft, typically between ages 7 and 11. The graft fills the gap in the upper jaw before the permanent canine erupts.[1]
An oral and maxillofacial surgeon usually performs this procedure. Bone is most often taken from the hip (iliac crest). The graft supports the teeth, stabilizes the upper jaw, and creates a foundation for braces or future implants. Learn more about the oral-surgery page for details on this phase of care.
Orthodontics and Jaw Surgery
Children with clefts often need braces in two phases. Early braces align the upper jaw before the bone graft. Later braces straighten the permanent teeth.
Some teens need orthognathic (jaw) surgery in late adolescence if the upper jaw has not grown forward enough. This surgery is timed after facial growth is complete, usually around age 16 to 18.
Speech Therapy and ENT Care
Many children with cleft palate need speech therapy. A small group needs additional surgery, called pharyngeal flap or sphincter pharyngoplasty, to improve airflow during speech.
Ear infections are common because the cleft affects the muscles around the eustachian tube. Ear tubes are often placed at the time of palate repair to protect hearing.
Recovery and Aftercare
Recovery varies by procedure. Lip and palate repairs in infancy heal in two to four weeks. Bone grafts and jaw surgery in older children take longer.
After Infant Surgery
After lip repair, parents use arm restraints for one to two weeks to keep the baby from rubbing the incision. Feeding is restarted with a syringe, cup, or soft nipple based on the surgeon's plan.
After palate repair, babies eat soft or pureed foods for two to three weeks. No straws, hard foods, or pacifiers during healing. Pain is managed with infant-safe medication.
After Bone Graft or Jaw Surgery
After alveolar bone grafting, children eat a soft diet for several weeks. Brushing is done gently, and the orthodontist pauses tooth movement until the graft heals, usually 8 to 12 weeks.
Jaw surgery recovery takes longer. Most teens return to school in two to three weeks and to full activity in six to eight weeks. Full bone healing continues for several months.
Long-Term Follow-Up
Children seen by a cleft team typically have annual visits through age 18 to 21. Follow-up covers speech, hearing, dental health, jaw growth, facial appearance, and emotional well-being.
Some adults choose dental implants to replace missing teeth near the cleft. Implants are usually placed after jaw growth is complete, often after orthodontic alignment is finished.
Cost Factors
Cleft care is staged across many years, so total costs add up across surgeries, orthodontics, speech therapy, and dental work. Costs vary by location, provider, and case complexity.
Single procedures range widely. Lip repair surgery typically ranges from $5,000 to $15,000. Palate repair ranges from $7,000 to $20,000. Alveolar bone grafting ranges from $4,000 to $10,000. Orthognathic surgery in adolescence can range from $20,000 to $40,000 or more.
Most medical insurance plans cover medically necessary cleft repair, including primary surgery, bone grafting, and ENT care. Coverage for orthodontics is less consistent. Some states require coverage of cleft-related orthodontics, while others do not. Speech therapy is often covered through medical insurance or early intervention programs.
Families with limited coverage may qualify for help through Medicaid, the Children's Health Insurance Program (CHIP), state cleft programs, or hospital financial aid. Nonprofit groups also fund care for some families. Confirm benefits and out-of-pocket costs with the surgical team and insurer before each phase.
When to See a Specialist
Cleft care is specialty care from the start. A general dentist or pediatrician is rarely the right setting for surgical decisions. Families should be referred to a cleft and craniofacial team soon after diagnosis.
An oral and maxillofacial surgeon plays a central role in later phases of treatment, especially alveolar bone grafting and jaw surgery. Plastic surgeons typically lead lip and palate repair in infancy. Orthodontists, speech pathologists, ENTs, pediatric dentists, and geneticists round out the team.
Look for a team accredited by the American Cleft Palate-Craniofacial Association. Accredited teams meet standards for staffing, coordination, and long-term follow-up. Care at a non-team setting is generally not recommended for primary surgery or major bone grafting.
Find a Specialist
If your child has been diagnosed with a cleft lip or palate, connect with an experienced cleft and craniofacial team. An oral and maxillofacial surgeon can guide bone grafting and jaw surgery as part of that team. Use the directory to find specialists with cleft experience near you and review their training, hospital affiliations, and team accreditation.
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