How is cleft lip and palate treated?

Babies born with a cleft will need at least one operation to close their cleft.

Usually, a cleft lip will be repaired at 3-6 months, while a cleft palate will be repaired at 6-12 months.

Depending on the kind of cleft someone is born with and how it affects them, they may have more operations as they grow up. These can help with things like:

• Speech: a cleft palate can affect someone’s speech, and sometimes speech therapy alone isn’t enough to help with this.
• Teeth: a cleft which goes through the gums might cause missing or misshapen teeth.
  • Children may need an Alveolar Bone Graft when they are 7-12 years old to make sure their adult teeth come through properly.
  • When the face stops growing (16-18 years old), young people may be offered jaw surgery to help with their ‘bite’.
  • Other procedures could include restorative dentistry such as implants or bridges.
• Appearance: Operations to change the shape of the nose, lips, or the appearance of a lip scar may be offered. These might also help with breathing.

Some people born with a cleft will only need one operation when they are a baby. Others will have many more as they grow up and into adulthood.

Your soft palate (the bit towards the back of the throat) is part of the mechanism that blocks off your mouth from your nose while you make certain sounds.

A cleft palate can make speech sound nasal or make some sounds unclear, especially consonants like t, b and d.

Children with a cleft palate may need some form of Speech and Language Therapy to help them speak clearly.

Usually an assessment is carried out with the Cleft Team and if treatment is needed, it is carried out by local providers. Local treatment may be given individually or in a group depending on what is needed and what is available in the area.

In some cases, Speech and Language Therapy alone won’t be enough to help with some speech issues. If this happens, the Cleft Team might recommend one or more operations to improve how the palate functions.

The goal is for children to have clear, intelligible (understandable) speech by the age of five so they can start school with confidence.

Treatment can be also available to adults with speech concerns.

Many children with a cleft palate will have issues with their hearing, more specifically ‘glue ear’, which can be recurring.

It can be treated using grommets or hearing aids.

This usually clears up by the time they are 6-8 years old, but will affect children in different ways as they grow up, and some children will have long-term issues.

These issues can develop gradually, so it’s important for parents and carers to be on the lookout for changes in their child’s hearing and make sure they get the treatment they need.

People born with a cleft can have a higher risk of tooth decay due to the placement or shape of some of their teeth. They may need extra attention from a dentist to keep their teeth and gums strong and healthy. Parents need to take extra care to maintain good dental health in children.

If a cleft affects the gum, children will usually need some kind of orthodontic treatment such as wearing braces or a retainer. They may need an Alveolar Bone Graft operation to help their adult teeth to come through properly.

For adults, dental and orthodontic work for issues caused by a cleft should be available on the NHS at the usual rates. You should not have to pay extra for private dental treatment if it is something which is necessary. You may also be able to get specialist assessment and treatment from an NHS Cleft Team. Learn more.

Clinical Psychologists work in or with many Cleft Teams to support individuals and families affected by cleft lip and palate. You can ask for an appointment from diagnosis right through until adulthood.

You don’t need to have a ‘psychological problem’ to see the Psychology team, they are there to talk as and when you need them. Through meeting with families and individuals they try to find out if more support is needed.

Some of the reasons you might see a Clinical Psychologist from your Cleft Team include:

• Talking to someone about worries you have about your or your child’s treatment
• Help making decisions about treatment
• Extra support during times of change, like starting school or moving into secondary school
• You and/or your family have trouble talking about or coming to terms with a cleft lip and/or palate
• Problems with bullying or teasing
• Building confidence and self-esteem
• Coping with things that can’t be changed or ‘fixed’ with surgery
• Help to come up with coping strategies for things like staring or comments

Clinical Psychologists with Cleft Teams are specialists who understand the specific issues which can face people affected by cleft lip and/or palate.

Appointments usually happen at the Cleft Centre, but further treatment and support, if necessary, often happens using local services.

Cleft is a complicated condition, and we don’t fully understand how it is caused. What we do know is that it’s usually caused by a mix of many different genetic and environmental factors.

Genetic counselling provides support, information and advice about genetic conditions. You can have genetic counselling through your NHS Cleft Team which can help you to understand if and how genetics played a part in your or your child’s cleft.

This can help you to understand the chances of passing on a cleft to any future children.

You can ask for this from your Cleft Team at any time during the treatment pathway. You do not need to be thinking about having children to ask for genetic testing.

More about genetic testing