Surgery for cleft lip and palate as part of a coordinated team, from infant repairs to alveolar bone grafting and jaw surgery in the teen years.
A cleft lip or cleft palate is an opening in the lip, the roof of the mouth, or both, that forms early in pregnancy. It is one of the more common differences present at birth. With coordinated care, children born with a cleft grow up to eat, speak and smile well. Treatment happens in stages from infancy into the late teens, and it works best when everyone involved is part of one team.
A team, not a single surgeon
Molly's cleft care is led by a craniofacial surgeon working with our oral and maxillofacial surgeons, and is offered at our Newport Beach, La Jolla and Pasadena offices. We work closely with a multidisciplinary cleft team that typically includes a pediatrician, orthodontist, speech-language pathologist, ear, nose and throat specialist, audiologist, feeding specialist, pediatric dentist and social worker. Team visits mean your child is seen by the right people at the right time, and that decisions are made together.
The usual stages of treatment
Every child's plan is individual, but a typical timeline looks like this:
- Before surgery. Feeding support from birth. Some babies benefit from a molding device to narrow the gap before the lip repair.
- Lip repair, usually around 3 to 6 months of age.
- Palate repair, usually between 9 and 18 months, before speech develops, to help normal speech and feeding.
- Speech and hearing care through childhood, sometimes with a further procedure to improve speech.
- Alveolar bone grafting, typically between ages 7 and 11, before the adult canine tooth erupts. Bone, usually from the hip, fills the gap in the gum ridge so teeth can come in and the arch is stable.
- Corrective jaw surgery in the teen years for some patients, when the upper jaw hasn't grown forward enough. See corrective jaw surgery.
- Final refinements, such as lip or nose revision and implants for missing teeth, once growth is complete.
Surgery and support
Infant and childhood cleft surgeries are performed in a children's hospital under general anesthesia by surgeons experienced in pediatric care. Planning for alveolar bone grafts and jaw surgery uses 3D cone-beam CT (CBCT) imaging. Your surgeon explains each stage well ahead of time, what recovery will involve, and how to care for your child at home. The 24/7 surgeon line is there for any question, any night.
Adults who had cleft surgery as children are welcome too. Many come to us for bone grafting, jaw surgery or implants they didn't have earlier. Cleft care is billed to medical insurance, and children in California may also be eligible for California Children's Services (CCS). We help families with the paperwork.
