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Treatments

General Cleft Care and Treatment Plans
The medical care for a child with cleft involves a complex and long-term plan of care that will involve a series of surgeries that stretches to adulthood.
• Our craniofacial surgery team will work closely with you and your child to develop a plan that requires the least interventions and provides the best results for your child.
• Although treatment for a cleft lip and/or cleft palate may extend over several years and require several surgeries (depending upon the severity of the condition), most children affected can achieve normal appearance, speech and eating abilities.

Cleft lip
• Repair of a cleft lip may need one or two surgeries depending on the extent of the malformation.
• The first surgery is usually performed when your baby is about 3 months old.
• This surgery involves moving the skin, muscle and lining in the proper place. The nose may also be shaped to improve its form.

Cleft palate
• The initial surgery usually occurs when your baby is between 9 and 12 months old.
• This first surgery creates a functional palate, which reduces the chances that fluid will develop in the middle ears, and allows for the proper development of speech.
• Your child may also need a bone graft at about 8 years old to fill in the upper gum line so that it can support permanent teeth and stabilize the upper jaw.
• Further surgeries to help improve speech are required by about 20 percent of children with a cleft palate.
o Braces may also be needed to straighten the teeth.
• Additional surgeries to improve the appearance of the lip and nose, close openings between the mouth and nose, help breathing, and stabilize and realign the jaw may also be performed.

General Cleft Care and Treatment Plan

The following outlines a general care and treatment plan, but is not all-inclusive, nor applicable to every child.

Prenatal
Evaluation by our craniofacial team
Diagnosis and genetic counseling provided
Psychosocial issues addressed
Feeding instructions provided
Feeding plan developed

Birth to 1 month
Evaluation by our craniofacial team
Diagnosis and genetic counseling provided
Psychosocial issues addressed
Feeding instructions provided and growth monitored

1 to 4 months
Feeding and growth monitored
Cleft lip repaired
Ears and hearing checked

5 to 15 months
Feeding, growth and development checked
Ears and hearing checked; ear tubes may be required
Cleft palate repaired
Oral hygiene instructions provided

16 to 24 months
Ears and hearing assessed
Speech and language evaluated
Development assessed

2 to 5 years
Speech and language assessed; velopharyngeal insufficiency managed
Ears and hearing checked
Lip and nose revision may be considered
Development and psychosocial adjustment evaluated

6 to 11 years
Orthodontic interventions performed
Speech and language assessed; velopharyngeal insufficiency managed
Alveolar bone graft done
School/psychosocial adjustment assessed

12 to 21 years
Jaw surgery and rhinoplasty performed, if needed
Orthodontic bridges and implants provided, if needed
Genetic counseling provided
School/psychosocial development assessed