Materiały źródłowe

• #1 Cleft lip and cleft palate – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cleft-palate/diagnosis-treatment/drc-20370990

  Surgery to repair cleft lip creates a more typical lip appearance, structure and function. Surgery is done in a way to minimize the appearance of the scar. The goals of treatment for cleft lip and cleft palate are to make it easier for a child to eat, speak and hear and achieve a typical look for the face. […] Treatment involves surgery to repair cleft lip and cleft palate and therapies to make any related conditions better. […] Surgery to correct a cleft lip and cleft palate is based on your child’s situation. Following the initial cleft repair, your healthcare professional may recommend follow-up surgeries to make speech better or make the lip and nose look better. […] Cleft lip and cleft palate surgery takes place in a hospital. Your child will get medicine to go to sleep and not feel pain or be awake during surgery. Surgeons use several techniques and procedures to repair cleft lip and palate, reconstruct the affected areas, and prevent or treat related complications.

• #2 Cleft lip and cleft palate – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cleft-palate/diagnosis-treatment/drc-20370990

  Surgery can improve your child’s quality of life and make your child eat, breathe and talk better. Possible risks of surgery include bleeding, infection, poor healing, widening or raised scars, and short- or long-term damage to other structures. […] Your healthcare professional may recommend more treatment for other functional and structural changes that cleft lip and cleft palate cause, such as: Feeding strategies, such as using a special bottle nipple or feeder. Speech therapy to make it easier to speak. Orthodontic adjustments to the teeth and bite, such as having braces. Monitoring by a pediatric dentist for tooth development and oral health from an early age. Monitoring and treatment for ear infections, which may include ear tubes. Monitoring hearing and providing hearing aids or other devices to a child with hearing loss. Therapy with a psychologist to help the child cope with the stress of repeated medical procedures or other concerns. Regular screening and treatment for health problems is mostly limited to the first two decades of life, but lifelong monitoring may be needed depending on your child’s individual health problems.

• #3 Cleft Lip and Palate Treatment

  https://www.nationwidechildrens.org/specialties/cleft-lip-and-palate-center/about-cleft-lip-and-palate/cleft-lip-and-palate-treatment

  The treatment of a child born with cleft lip and/or cleft palate begins at birth and continues into young adulthood. The neonate with cleft palate will require special feeding techniques in order to ensure adequate caloric intake and weight gain. Surgical repair is begun in early infancy, and secondary surgical procedures may be required throughout growth and development. Cleft lip treatment and/or cleft palate treatment does not end, however, with operative repair. Comprehensive care of the child with cleft lip and/or palate includes expert professional attention to speech and hearing, dental and orthodontic needs, and psychosocial well-being. […] The goal of cleft lip surgery is to restore normal appearance and function to the upper lip. Cleft lip surgery is usually recommended at three to four months of life. In most cases, the tissue in the area around the cleft is rearranged to close the opening. An important part of the surgery involves detaching and re-positioning the muscle of the lip to recreate the circular muscle around the mouth.

• #3 Cleft Lip and Palate Treatment

  https://www.nationwidechildrens.org/specialties/cleft-lip-and-palate-center/about-cleft-lip-and-palate/cleft-lip-and-palate-treatment

  Cleft palate repair is typically performed on infants that are between 6 and 18 months of age. Since the primary goal of repairing the palate is to avoid any abnormal speech development, the surgery is scheduled earlier before the child develops much speech. […] The majority of children born with cleft palate will need speech-language therapy at some point in their life. A speech-language pathologist is the healthcare professional that provides speech-language therapy, which may be in the medical setting, school setting, private clinic, or home-based intervention program. The goals of speech-language therapy are to provide the child with the knowledge and skills to achieve normal speech and communication for their age or developmental level. […] Treatment of children with facial differences may start as early as one week old and continues through adolescents into early adulthood with two to three different phases of treatment.

• #4 Cleft Lip & Cleft Palate: Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/10947-cleft-lip-cleft-palate

  Cleft lip and palate are separations in the upper lip and mouth that occur while a fetus develops in the uterus. Treating cleft lip and palate involves surgery and may include speech therapy and dental work. […] Surgery can repair a cleft lip and/or cleft palate. […] Treatment for cleft lip and cleft palate begins at birth. Surgical treatment begins as early as 3 months and can last until the teen years. […] Surgery treats cleft lip and/or cleft palate. The exact details of treatment depend on the extent of the cleft, your child’s age and other special needs or health conditions. Your child will have surgery at a hospital, under general anesthesia, so they’ll be asleep during the procedure. […] A cleft lip repair may require one or two surgeries. The first surgery usually occurs when your baby is between 3 and 6 months old. This surgery closes their lip. The second surgery, if necessary, is usually done when your child is 6 months old.

• #4 Cleft Lip & Cleft Palate: Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/10947-cleft-lip-cleft-palate

  Cleft palate surgery usually occurs when your baby is 12 months old. It creates a working palate and reduces the chances that fluid will develop in your baby’s middle ears. […] Up to 40% of children with a cleft palate will need further surgeries to help improve their speech. […] Children often need treatment beyond surgery for cleft lip or palate. Some other treatments their healthcare providers may recommend are speech therapy and orthodontic treatment. […] Because of the number of oral health and medical problems associated with a cleft lip or cleft palate, it takes a team of healthcare providers working together to develop a comprehensive care plan. Your child’s treatment usually begins in infancy and often continues through their early adulthood.

• #5 Cleft Palate & Cleft Lip | Lurie Children’s

  https://www.luriechildrens.org/en/specialties-conditions/cleft-lip-cleft-palate/

  Cleft lip and palate are congenital abnormalities (an abnormality present at birth) caused by a failure in facial development during pregnancy. […] The results of treatment for cleft lip and palate are usually excellent both aesthetically and functionally. Children born with these conditions have a good quality of life and a normal life expectancy. […] A cleft lip is usually repaired surgically when the baby is between three to six months old. An orthodontic appliance may be used before and after the lip repair surgery to help align the lip and nose. […] A cleft palate is usually repaired between 10 and 12 months of age. The plastic surgeon carefully puts the tissue and muscles in a better position so that the opening between the nose and mouth is closed and the roof of the mouth is rebuilt.

• #6 Cleft Palate (for Parents) | Nemours KidsHealth

  https://kidshealth.org/en/parents/cleft-palate.html

  A cleft palate usually is repaired with surgery called palatoplasty when the baby is 10-12 months old. The goals of palatoplasty are to: […] Most kids with cleft palate are treated successfully with no lasting problems. A team experienced in treating children with cleft lip and palate can create a treatment plan tailored to your child’s needs. […] Some kids with cleft palate may need other surgeries as they get older. These might include: Speech surgery: Children can develop speech problems even after the palate has been repaired. At your regular appointments with the cleft team, the speech-language pathologist will carefully listen to your child’s speech to help the surgeon decide if another surgery is needed to improve speech. […] It’s important to work with a care team experienced in treating children with cleft lip and palate. Besides the pediatrician, a child’s treatment team will include: a patient care coordinator, cleft surgeon (pediatric plastic surgeon or oromaxillofacial surgeon with cleft care experience), ear, nose, and throat (ENT) surgeon (otolaryngologist), orthodontist, speech-language pathologist, audiologist.

• #7 The Management of Cleft Lip and Palate: Pathways for Treatment and Longitudinal Assessment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2884751/

  We have had consistently very high satisfaction rates with our CLIF clinic. […] The initial visit may also be the first opportunity for the plastic surgeon to grade the cleft and counsel parents on what is involved in cleft surgery and what to expect in the first year of life. […] The timing of the lip repair is generally between 2 and 3 months of age, calculated from the expected due date. […] The choice of procedure is up to the plastic surgeon and related to the clinical presentation. […] The majority of our cleft palate repairs are done using the two-flap palatoplasty technique using bilateral palatal flaps based on the greater palatine vessels to close at the midline. […] The initial speech evaluation is completed between 12 and 14 months of age. […] When VPI is diagnosed, all efforts are made to maximize medical management.

• #7 The Management of Cleft Lip and Palate: Pathways for Treatment and Longitudinal Assessment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2884751/

  The sphincter pharyngoplasty has been our surgical workhorse in managing VPI that has not responded to speech therapy. […] Cleft lip/nose deformities are considered as social integration occurs (school age). […] Bone grafting usually takes place between ages 7 and 9 and serves several purposes. […] Dental care starts at a very young age for the cleft patient. […] Orthognathic surgery is usually performed in the early teen years, ages 12 to 15. […] The definitive rhinoplasty is often the last major surgical procedure to be done in cleft cases. […] Cleft patients are considered patients of the craniofacial center for life.

• #7 The Management of Cleft Lip and Palate: Pathways for Treatment and Longitudinal Assessment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2884751/

  The care of children with cleft deformities is best managed by a dedicated team of specialists committed to their care from the time of diagnosis until adulthood. […] The management of cleft lip and palate represents a commitment to the care of the afflicted child over the course of the child’s development into adulthood. […] The role of a qualified surgeon in this population of patients is obvious; however, the special needs of children with clefts are best served by the participation of a craniofacial team. […] A road map of surgical and nonsurgical care that is needed for each patient from the initial visit is created. […] The importance of the multispecialty approach to the care of children with clefts cannot be overemphasized. […] The craniofacial team is composed of nursing and physician specialists with particular interest and training in the care of children with cleft deformities.

• #7 The Management of Cleft Lip and Palate: Pathways for Treatment and Longitudinal Assessment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2884751/

  One of the first consultations is with the feeding specialist, who assists families with managing the special feeding needs of cleft newborns. […] Feeding problems accompanying a diagnosis of cleft lip, cleft palate, or both have been widely documented in the literature, as well as the potential consequences of these feeding difficulties. […] At Children’s Healthcare of Atlanta’s Center for Craniofacial Disorders, we have listened to the parents and developed the Craniofacial/Lactation Infant Feeding (CLIF) clinic to address the feeding concerns for this population. […] During this visit the family meets with the feeding team, which consists of a nutritionist, a feeding specialist (either occupational or speech therapy), and a lactation counselor. […] The severity of issues (e.g., weight status, severity of cleft, respiratory issues, ability to feed orally) assists with determining how quickly the infant needs to be seen by the surgeon or other specialists.

• #7 The Management of Cleft Lip and Palate: Pathways for Treatment and Longitudinal Assessment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2884751/

  The feeding specialist performs an oral evaluation to assess the cleft and the effects it might have on feeding, the infant’s feeding reflexes, and the strength and function of the oral anatomy. […] The type of cleft is determined and classified as bilateral, unilateral, or horseshoe shaped and complete or incomplete. […] If an infant appears to have an isolated cleft lip, cleft palate, or both with no apparent respiratory issues, we usually try the Pigeon nipple first. […] The advent of bottles with one-way valves that use compression (positive pressure) versus suction (negative pressure) has offered new and improved ways for parents to feed their infants. […] After the correct feeding device is decided upon, the parents are given visual and written instructions on how to use and care for it.

• #8 Cleft Lip and Palate Repair Surgery | Children’s Hospital of Philadelphia

  https://www.chop.edu/treatments/surgical-repair-cleft-lip-and-palate

  The surgical procedures required for each patient with cleft lip and palate will vary depending upon the type and severity of the deformity. […] The Division of Plastic, Reconstructive and Oral Surgery at Children’s Hospital of Philadelphia is one of the nations leading centers for treating cleft lip and palate. Our team performs more than 1,000 surgical repairs each year. […] For more details about your childs specific procedure and follow-up care, please consult your surgeon or other members of your Cleft Lip and Palate Program team. We are available any time to answer all of your treatment questions. […] The goal of cleft lip surgery is to repair the separation of the lip. […] Cleft palate repair is a more complicated surgery and has the best outcome when the child is slightly older and better able to tolerate the surgery, but before significant speech development occurs.

• #8 Cleft Lip and Palate Repair Surgery | Children’s Hospital of Philadelphia

  https://www.chop.edu/treatments/surgical-repair-cleft-lip-and-palate

  Surgical repair of cleft palate separates the oral and nasal cavities. This separation involves the formation of a watertight and airtight valve that is necessary for normal speech. […] Once the lip and palate are repaired, typically no further surgery is performed for several years. […] Alveolar bone grafting creates a more complete dental arch, and space for permanent teeth to erupt, by placing bone along the alveolus where it is deficient. […] If the patient has a significant nasal deformity, an intermediate rhinoplasty may be performed. […] Orthodontic treatment may consist of several phases of treatment, lasting several years each. […] Cleft palate patients commonly have underdevelopment of the maxilla (upper jaw), resulting in maxillary retrusion. […] The goal of treatment is to complete all procedures by the time a patient reaches skeletal maturity (usually around age 18).

• #9 Cleft Lip and Cleft Palate Treatment Options

  https://www.kidsplastsurg.com/cleft-lip-palate/treatment-options/

  To repair a cleft lip, the surgeon will make an incision on either side of the cleft from the mouth into the nostril. The goal in lip repair is to create a structure of normal appearance and function. […] Repair of the palate is directed at producing normal speech, restoring Eustachian tube function, attaining closure of oronsasal fistulas, and minimizing alterations in maxillary growth. […] To repair a cleft palate, the surgeon will make an incision on both sides of the separation, moving tissue from each side of the cleft to the center or midline of the roof of the mouth. This rebuilds the palate, joining muscle together and providing enough length in the palate so the child can eat and learn to speak properly. […] Children with clefts including the alveolar dental arch will require bone grafting to maintain the dental arch and allow the ingrowth of teeth immediately adjacent to or within the cleft.

• #9 Cleft Lip and Cleft Palate Treatment Options

  https://www.kidsplastsurg.com/cleft-lip-palate/treatment-options/

  In a small percentage of cases, some children, in spite of cleft palate repair, will continue to exhibit hypernasal speech. […] The condition known variously as velopharyngeal insufficiency (VPI) or velopharyngeal dysfunction (VPD) may be seen after cleft palate surgery or noted after adenoidal tissue undergoes involution as the child grows. […] In those cases, consultation with the Cleft Palate Team will most likely result in a recommendation for some type of surgical intervention to help with the soft palate closure. […] Surgical procedures for correction of velopharyngeal insufficiency include pharyngeal flaps, in which the posterior pharyngeal wall is elevated and sutured to the soft palate, thereby reducing the gap present from the short or poorly functioning soft palate.

• #10 Cleft Lip and Cleft Palate Surgery | Duke Health

  https://www.dukehealth.org/pediatric-treatments/pediatric-plastic-and-reconstructive-surgery/cleft-lip-and-cleft-palate

  Children with a cleft lip and/or cleft palate can face many medical, dental, and developmental challenges. […] Our team includes surgeons who use advanced surgical techniques to close clefts, as well as specialists who focus on helping your child speak, feed, and eat successfully. […] Nasoalveolar molding (NAM) is a pre-surgical, custom-made orthopedic appliance that brings together the two sides of a cleft lip or palate and narrows a wide cleft. […] When a cleft lip is present, it is important to evaluate whether nasoalveolar molding (NAM) is appropriate for your baby and start the process early. […] Cleft lip surgery (cheiloplasty) closes the opening in the lip inside and outside the mouth. […] Gingivoperiosteoplasty (GPP) connects the two sides of the gum line to encourage bone growth from one side to the other.

• #10 Cleft Lip and Cleft Palate Surgery | Duke Health

  https://www.dukehealth.org/pediatric-treatments/pediatric-plastic-and-reconstructive-surgery/cleft-lip-and-cleft-palate

  Cleft palate surgery (palatoplasty) closes the opening in the palate. […] Speech-language assessments and therapy begin at age 1. […] Some children may require a second palate surgery. […] Alveolar bone grafting is performed to add bone to the upper jaw. […] Jaw surgery (orthognathic surgery) may be recommended around age 17 to align the upper and lower jaw when orthodontic treatment alone cannot correct the problem. […] Our cleft and craniofacial team is well-established and one of the oldest in the region. […] Our experience repairing clefts includes a special focus on your child’s ability to speak, feed, and eat successfully. […] Individualized care is very important to us, so all care is tailored to make your child and family feel comfortable and valued.

• #11 Cleft Palate Repair Treatment & Management: Medical Therapy, Surgical Therapy, Follow-up

  https://emedicine.medscape.com/article/1279283-treatment

  Multiple protocols for the management of cleft lip/palate have been suggested over the years by various authors. Today, the mainstream of cleft repair calls for closure of the lip at an early age (from 6 wk to 6 mo), followed by closure of the palate secondarily approximately 6 months later. This protocol has little impact on facial development. […] The list of surgical techniques used in palatal cleft closure is extensive. The repairs differ depending upon whether the cleft is an isolated cleft palate or part of a unilateral or bilateral cleft lip and palate. The 3 main categories include (1) simple palatal closure, (2) palatal closure with palatal lengthening, and (3) either of the first two techniques with direct palatal muscle reapproximation. […] The simple palatal closure was introduced by von Langenbeck and is the oldest cleft palate operation in wide use today.

• #11 Cleft Palate Repair Treatment & Management: Medical Therapy, Surgical Therapy, Follow-up

  https://emedicine.medscape.com/article/1279283-treatment

  The 4-flap technique is similar to the Wardill-Kilner 2-flap technique, except the oblique incisions are more posterior to create 4 unipedicle flaps. […] Several studies have emphasized the necessity of realignment of the muscle in the soft palate. […] The closure of the hard palate in Furlow’s technique avoids the use of lateral relaxing incisions. […] The main goals are complete closure of the entire cleft without tension at an early age (2 mo), with minimal exposure of raw bony surfaces and the creation of a functioning soft palate. […] In unilateral clefts the soft palate is closed first, followed by lip surgery 3 weeks later. […] Despite the difference in surgical technique, a general postoperative routine exists. […] The complications of great concern in the immediate postoperative period are bleeding and respiratory distress, yet the true incidence of these complications is difficult to determine from a review of the literature.

• #11 Cleft Palate Repair Treatment & Management: Medical Therapy, Surgical Therapy, Follow-up

  https://emedicine.medscape.com/article/1279283-treatment

  A fistula of sufficient size can lead to significant problems, ranging from oral fluid and food regurgitation into the nasal chamber to speech difficulties secondary to nasal air emission. […] The analysis of velopharyngeal competence after various techniques is difficult to interpret in the different studies. […] The management of a patient with cleft palate is complex. No current universal agreement exists on the appropriate treatment strategy. Several main points should be emphasized. Normal speech should be the most important consideration in the therapeutic plan. […] The authors believe, as do many others, that repair of cleft palate to establish a competent velopharyngeal sphincter should be completed at age 6-12 months.

• #12 Cleft Lip & Palate Association

  https://www.clapa.com/treatment/timeline/

  Every cleft is unique, just like every child, and everyone going through the care pathway will have different needs which will be handled by the individual cleft teams. […] The lip repair usually takes place when a child is at least 3 months old. […] The palate repair usually takes place between 6-12 months. […] Speech and Language Therapy Assessment – This usually takes place at around 18 months. Treatment will be offered if necessary, but the need may not become apparent until the child is older. […] An Alveolar Bone Graft (ABG) procedure is performed when there is insufficient bone in the area of the gum-line defect. […] Surgery may be required or requested for a number of different reasons, e.g. rhinoplasty (surgery to change the shape of the nose), dental surgery, lip revision, speech revision, palatal fistulae closure (closing small holes in the palate), etc. […] Adults may re-enter the cleft service at any time for a consultation about any aspect of their care, including psychological support, genetic counselling and specialist dental treatment, which is all available on the NHS if it is deemed necessary.

• #13

  https://childrens.wvumedicine.org/cleft-lip-and-cleft-palate

  Some patients may need minor surgery to improve the alignment of the lip lines. The shape of the nose can also be improved with surgery. […] If a child continues having speech problems after palate repair, another surgery may be needed. A pharyngoplasty or a pharyngeal flap procedure is a procedure that can improve the function of the pharynx, which is the tissue at the back of the mouth. Only about 10 to 15 percent of children need this speech surgery. […] Some children will need an alveolar bone graft. The alveolar bone is the bone under the gums where the teeth are attached and can also have a cleft (gap). A bone graft, usually taken from the childs hip, can close this gap and provide bone for the adult teeth to go in this space. […] Children born with cleft palate will sometimes develop a misaligned jaw where the lower jaw protrudes out further than the upper jaw (called an underbite). The team may recommend a surgery to help re-align the jaw. This might be a two-stage surgery called distraction osteogenesis for big differences or a one stage surgery called orthognathic surgery (jaw surgery) for smaller differences. […] Some children will need a rhinoplasty, or nose repair surgery, to correct the appearance, alignment, and air flow of the nose. […] At any time during your childs treatment plan, we may be able to perform small revision surgeries or touch ups to help improve self-confidence and esteem.

• #13

  https://childrens.wvumedicine.org/cleft-lip-and-cleft-palate

  It is common for children with cleft palate to have a procedure to insert ear tubes in the middle ear. These tubes help drain fluid to improve hearing and prevent infection. […] Children and families should establish a dental home with a pediatric dentist by the end of the first year. This ensures children get complete oral care throughout their cleft lip and palate treatment. Good dental hygiene is critical in the treatment of cleft. […] A speech therapist will closely monitor your childs development to spot signs of impairment. Regular checkups with a pediatric dentist can help address common dental problems, such as missing teeth, extra teeth, or cavities. […] If the pharynx (tissue at back of mouth) does not close properly, a child may continue having speech problems after palate repair. Another speech surgery may be needed. A palatal lengthening, pharyngoplasty or a pharyngeal flap procedure is a procedure that can improve the function of the pharynx. Only about 10 to 15 percent of children need this speech surgery.

• #13

  https://childrens.wvumedicine.org/cleft-lip-and-cleft-palate

  The repair of a cleft lip or palate is a process. Each phase of treatment builds on the treatment before. We monitor your childs progress continually. We address complications if they arise and keep you informed at every stage. […] Treatment usually beings with some form of nonsurgical molding. This is either nasoalveolar molding (NAM) or lip taping in the first few weeks after birth. This treatment uses tape or a dental plate to reduce the size of the cleft by bringing together the two sections of skin and muscle. This can be a helpful tool in cleft care but is not absolutely necessary. […] Typically, children with cleft lip will usually have this repaired around five to six months of age. A second repair surgery for the cleft palate will usually be performed between 10 and 12 months of age before speech begins. There are some circumstances where this repair needs to be delayed a few months.

• #14 Cleft Lip and Cleft Palate Diagnosis and Treatment at OHSU

  https://www.ohsu.edu/doernbecher/cleft-lip-and-cleft-palate-diagnosis-and-treatment

  Up to 30% of children with cleft palates develop velopharyngeal dysfunction. […] For children with this condition, we may recommend a speech appliance or surgery. […] About 20% of children may need palatal lengthening surgery at age 4 or 5. […] Your care team will help you find a dentist in your community who can provide follow-up care for cleft lip and cleft palate. […] Children may start orthodontic care to straighten their teeth and improve how their jaws work. […] Some children may have an alveolar bone graft between ages 8 and 10 to repair a cleft in the gum. […] Children who had a cleft lip may have surgery when their face is fully developed to reduce scarring and improve appearance. […] Older teens may have nose and jaw surgery after theyre done growing to improve function or appearance.

• #14 Cleft Lip and Cleft Palate Diagnosis and Treatment at OHSU

  https://www.ohsu.edu/doernbecher/cleft-lip-and-cleft-palate-diagnosis-and-treatment

  Support for your childs speech and hearing […] Mental health and well-being services […] Access to our jaw surgery team. […] Your child may have up to 20 appointments in their first year. After this, your child will typically have appointments every six months or once a year. […] You will meet your childs care team and discuss treatment. Your child may have feeding therapy. […] You may use lip taping or NAM to prepare your child for cleft lip surgery. […] Cleft lip surgery usually happens at this age. Your childs surgeon will rebuild affected parts of your childs nose, mouth and face. […] Cleft palate surgery usually happens at this age. The cleft surgeon will close the cleft in the roof of the mouth and rebuild the palate. […] Your child will have speech and hearing therapy as needed.

• #15 Pediatric Cleft Lip and Palate Treatment & Management: Approach Considerations, Medical Therapy, Surgical Therapy

  https://emedicine.medscape.com/article/995535-treatment

  Age 3 months – Repair of CL (and placement of ventilation tubes). […] Age 6 months – Presurgical orthodontics, if necessary; first speech evaluation. […] Age 9 months – Speech therapy begins. […] Age 9-12 months – Repair of CP (placement of ventilation tubes if not done at the time of CL repair). […] Age 1-7 years – Orthodontic treatment. […] Age 7-8 years – Alveolar bone graft. […] Older than 8 years – Orthodontic treatment continues. […] Other surgical procedures can be performed in patients with severe clefts as necessary (see Surgical Therapy). […] Pediatricians used to strictly follow a rule of „three 10s” as a necessary requirement for identifying the child’s status as suitable for surgery (ie, weight 10 lb [4.5 kg], hemoglobin 10 g/dL, and age 10 wk). […] Anatomic differences predispose children with CLP and those with isolated CP to ear infections. For this reason, ventilation tubes are placed to ventilate the middle ear and prevent hearing loss secondary to otitis media with effusion.

• #15 Pediatric Cleft Lip and Palate Treatment & Management: Approach Considerations, Medical Therapy, Surgical Therapy

  https://emedicine.medscape.com/article/995535-treatment

  The most common surgical procedures for a child with a CLP anomaly are as follows: Repair of the CL, Repair of the CP, Revision of the CL, Closure and bone grafting of the alveolar cleft, Closure of palatal fistulae, Palatal lengthening, Pharyngeal flap, Pharyngoplasty, Columellar lengthening, CL rhinoplasty and septoplasty, Lip scar revision, LeFort I maxillary osteotomy. […] Orthodontic treatment is highly specialized and varies from case to case. The two stages of orthodontic treatment of a child with CLP are as follows: Surgery-related orthodontics – Early management (from birth until the time of surgical closure of the palate); orthodontics related to alveolar bone graft; permanent dentition management. […] There has been considerable enthusiasm for employing presurgical infant orthopedics (PSIO) in CLP patients to improve surgical outcomes with minimal intervention.

• #15 Pediatric Cleft Lip and Palate Treatment & Management: Approach Considerations, Medical Therapy, Surgical Therapy

  https://emedicine.medscape.com/article/995535-treatment

  Their review suggested that NAM does not alter skeletal facial growth but found evidence of benefits to patients, caregivers, surgeons, and society, including the following: Documented reduction in the severity of the cleft deformity before surgery and, as a consequence, improved surgical outcomes, Reduced burden of care on caregivers, Reduction in the need for revision surgery, Consequent reduced overall cost of care to patient and society. […] Gaining weight and preventing aspiration and ear infections are the most important parts of caring for neonates with a cleft during their first days and weeks of life.

• #15 Pediatric Cleft Lip and Palate Treatment & Management: Approach Considerations, Medical Therapy, Surgical Therapy

  https://emedicine.medscape.com/article/995535-treatment

  Because otitis media with effusion is very common among children with CP, involvement of an otolaryngologist in the multidisciplinary treatment plan is of great importance. The otolaryngologist performs placement of ventilation tubes in conjunction with the CP repair. […] No single treatment concept has been identified, especially for CLP. The timing of the individual procedures varies in different centers and with different specialists. […] The following is the most common treatment protocol currently used in most cleft treatment centers: Newborn – Diagnostic examination, general counseling of parents, feeding instructions, palatal obturator (if necessary); genetic evaluation and specification of diagnosis; empiric risk of recurrence of cleft calculated; recommendation of a protocol for the prevention of a cleft recurrence in the family.

• #16

  https://www.shrinerschildrens.org/en/pediatric-care/cleft-palate

  Here is an overview of what to expect. […] Shriners Childrens craniofacial specialists can provide the right care at the right time to give your child the best outcome. […] Our family-centered approach celebrates the journey of each and every patient, inviting the family to collaborate with specialists, crafting the best treatment plan for their child. […] The cornerstone of cleft care is really the two parts of multidisciplinary care and longitudinal care. […] When a family comes, it’s a very family-centered experience where the family will meet every specialist. […] If speech therapy alone does not help a child speak clearly, pharyngeal/soft palate surgery, typically between 3 and 6 years old, can improve the function of the soft palate which helps the child pronounce words correctly and corrects nasal-sounding speech.

• #16

  https://www.shrinerschildrens.org/en/pediatric-care/cleft-palate

  For all our surgeries, child life specialists can help children with coping skills, comfort and play, so parents can focus on helping the child heal. […] Shriners Childrens has child psychologists on the craniofacial team to help with individualized education programs and support patients with confidence, self-esteem or bullying issues. […] Shriners Childrens team care includes evaluation by audiologists and ear, nose and throat surgeons (otolaryngologists). […] The repair is completed by 1 year of age, before the childs first spoken words. […] Our speech language pathologists are an important resource because the palate is how children form words and sounds. […] Speech therapists at Shriners Childrens help every child have the chance to express themselves in a full, healthy life.

• #16

  https://www.shrinerschildrens.org/en/pediatric-care/cleft-palate

  Shriners Childrens offers hearing services to help screen and assess problems and possible hearing loss that may be associated with craniofacial and cleft conditions. […] Shriners Childrens offers specialized facial and dental imaging (X-rays) for children with craniofacial differences. […] Our specialists will evaluate your child and provide an individualized care plan.

• #17 Cleft Lip and Palate

  https://www.asha.org/practice-portal/clinical-topics/cleft-lip-and-palate/?srsltid=AfmBOopWZRsDZnN0cQTTZOXqrn2qyveghGy9TWPUrIfNUOq74nOl_CUx

  Treatment for children with clefts, other craniofacial conditions, and even noncleft velopharyngeal insufficiency (VPI) is best done through a cleft palatecraniofacial team. The team typically includes a patient care coordinator, nurse, or social worker who facilitates team function and efficiency, assists families, and coordinates care for individuals and families. Based on standards developed by the American Cleft Palate Craniofacial Association (ACPA, 2022), a cleft palate team must have, as a minimum, a surgeon, an orthodontist, and an SLP. […] Comprehensive teams may also include or have access to professionals in other fields, such as audiology, otolaryngology, ophthalmology, dentistry, genetics, nursing, psychology, and social work. Others may include oral maxillofacial surgeons, developmental pediatricians, geneticists, and plastic and craniofacial surgeons. Additional members vary depending on the individuals developmental, medical, and psychological needs. See Standards for Approval of Cleft Palate and Craniofacial Teams [PDF] (ACPA, 2022) for essential characteristics of quality for team composition and functioning.

• #17 Cleft Lip and Palate

  https://www.asha.org/practice-portal/clinical-topics/cleft-lip-and-palate/?srsltid=AfmBOopWZRsDZnN0cQTTZOXqrn2qyveghGy9TWPUrIfNUOq74nOl_CUx

  Surgical intervention or other physical management is needed to manage speech disorders resulting from VPD (e.g., hypernasality); hyponasality due to enlarged adenoids or enlarged turbinates; pervasive nasal air emission (and/or weak pressure on oral consonants); and malocclusion (e.g., orthognathic surgery to correct a Class II or Class III malocclusion). […] Direct speech therapy is appropriate for treatable articulation disorders, including compensatory misarticulations and phoneme-specific nasal air emission due to a pharyngeal placement on sibilants. […] The objectives of therapy are to correct abnormal placements for consonant misarticulations (e.g., bring backed oral articulations forward, teach correct oral place, and establish oral pressure buildup and release) and establish oral pathway/direction of airflow and appropriate valving of airflow at target place during production of oral sounds (Golding-Kushner, 2001; Ruscello, 2017; Trost-Cardamone, 2013).

• #17 Cleft Lip and Palate

  https://www.asha.org/practice-portal/clinical-topics/cleft-lip-and-palate/?srsltid=AfmBOopWZRsDZnN0cQTTZOXqrn2qyveghGy9TWPUrIfNUOq74nOl_CUx

  Treatment of children affected by clefts or other craniofacial conditions involves normalizing structure through physical management (surgical or orthodontic) and normalizing function through therapy. Treatment may also include early feeding intervention, dental care and orthodontics, audiologic care and monitoring of hearing status, and psychological services. See Parameters for Evaluation and Treatment of Patients With Cleft Lip/Palate or Other Craniofacial Differences (ACPA, 2018). […] Feeding disorders are among the first concerns following the birth of a child with cleft lip and palate. The goal of feeding intervention is to ensure adequate and efficient intake for appropriate hydration and nutrition, for growth and development, and for adequate medical status prior to surgery. […] An important additional goal is to ensure that feeding is a low-stress experience for the infant and their family (Reid, 2004). Health care providers (e.g., SLPs, nurses, or lactation consultants) instruct mothers in feeding techniques and reassure them that successful feeding can be accomplished with the least amount of stress for the infant and family (Goyal et al., 2014).

• #17 Cleft Lip and Palate

  https://www.asha.org/practice-portal/clinical-topics/cleft-lip-and-palate/?srsltid=AfmBOopWZRsDZnN0cQTTZOXqrn2qyveghGy9TWPUrIfNUOq74nOl_CUx

  A number of strategies and techniques can be used to facilitate feeding success prior to surgery, including placing the baby in an upright position while feeding to help prevent nasal regurgitation; providing jaw and cheek support, as needed; using the appropriate nipple size; positioning the nipple optimally (e.g., away from the side of cleft, if unilateral); pacing the flow rate and providing fluid in rhythm with the babys cues (e.g., movements and reactions); burping frequently to counter excessive air intake; and limiting feeding time (e.g., no more than 30 minutes) to avoid fatigue (Dailey, 2013; Peterson-Falzone et al., 2010, 2016). […] Some cleft palate centers offer nasoalveolar molding (NAM) for infants with cleft lip and palate before surgery. NAM is a presurgical appliance that is used prior to surgery to align maxillary segments; however, a secondary benefit is that the appliance can function as a dental plate. Some parents report improved feeding with a NAM appliance (Zajac Vallino, 2017b).

• #18 Pediatric Cleft Lip and Palate – MU Health Care

  https://www.muhealth.org/conditions-treatments/pediatrics/pediatric-plastic-surgery/cleft-lip-and-palate

  Our surgeons perform each of these surgeries on an inpatient basis, with your child spending one or two nights in the hospital. Additional revision or touch up surgeries may be done on the lip and/or nose before the child starts school. In addition, some children need additional surgery on their palates to improve their speech. […] If your baby has a cleft of the palate only, it is possible that only one surgery will be required to repair the palate. However, further surgery is occasionally required for speech problems. […] The optimal treatment of children with cleft lip and/or palate is achieved in a multidisciplinary setting, as children with cleft lip and/or palate have multiple issues like speech, hearing or facial growth. A number of different health care providers from various specialties work together to treat children with clefts, including: Plastic (craniofacial) surgeon, Speech/language pathologist, Orthodontist, Pediatric plastic surgery nurse, Otolaryngologist (ENT), Geneticist, Pediatric Psychologist/Neuropsychologist, Developmental pediatrician, Audiologist, Dietician.

• #19 Cleft Lip and Palate Program | Boston Children’s Hospital

  https://www.childrenshospital.org/programs/cleft-lip-and-palate-program

  Our comprehensive team of specialists includes: Plastic surgeons, Oral and maxillofacial surgeons, Dentists, Orthodontists, Nurses, Psychologists and social workers, Otolaryngologists (ear, nose, and throat doctors), Speech-language pathologists, Audiologists (hearing specialist), Clinical geneticists. […] This multidisciplinary team of specialists continually strives to provide the highest level of care possible. Our department also co-directs a highly advanced, 2,500-square-foot research laboratory where our doctors are studying the causes of cleft lip/cleft palate and researching new therapies. […] We routinely evaluate our treatment outcomes, our patients quality of life, and their satisfaction with care. Families consistently report high levels of satisfaction with our care team. […] Our center cares for a large number of patients and performs the highest volume of cleft-related operations in New England every year. We treat an average of 967 children with cleft lip and palate each year, ranging from infancy to young adulthood.

• #19 Cleft Lip and Palate Program | Boston Children’s Hospital

  https://www.childrenshospital.org/programs/cleft-lip-and-palate-program

  Because we constantly strive for improvement, in 2016, our center began prospectively tracking our cleft outcomes. We regularly evaluate the quality of our treatment to ensure we provide our patients the best care possible. We take pride in our low complication rates. Our long-term outcomes are comparable to or better than many other leading cleft centers, and we continually work to improve the care we provide. […] Here at Boston Childrens, our compassionate clinicians also understand the emotional and psychosocial toll cleft lip and cleft palate can cause. We recognize your child as an individual never just a patient and provide vital resources and support to meet the needs of your entire family. We also regularly measure our patients quality of life using the CLEFT-Q scale and other patient and parent-reported surveys.

• #20 Cleft Lip and Palate Diagnosis, Causes, Treatment | National Institute of Dental and Craniofacial Research

  https://www.nidcr.nih.gov/health-info/cleft-lip-palate

  Treatment for children with cleft lip or palate depends on the size of the cleft, the child’s age and needs, and whether there are additional problems related to a genetic syndrome. A child with cleft lip or palate is often referred to a team of experts that may include an otolaryngologist (ear, nose, and throat doctor), plastic surgeon, oral surgeon, speech pathologist, pediatric dentist, orthodontist, audiologist, pediatrician, nutritionist, and psychologist/social worker. […] Surgery is often used to close the lip and palate. Cleft lip surgery is usually done before a baby’s first birthday, and cleft palate surgery is done before 18 months. If there are other problems as they get older, a child may need additional surgeries, dental and orthodontic care, and speech therapy. With treatment, most children with cleft lip or palate do well and lead a healthy life.

• #21 Cleft lip and palate treatment | Children’s Wisconsin

  https://childrenswi.org/medical-care/plastic-surgery/craniofacial-disorder-conditions/cleft-lip-and-palate-program/cleft-lip-and-palate-treatment

  Care of children with cleft lip and palate is more than a series of operations during childhood. While every child is different, many need additional evaluation and treatment. […] Our team includes: Plastic surgeons Our surgeons serve as medical directors of the team and manage surgical correction of the lips, palates and gums, as well as later surgical correction of the nose and jaws when growth is impaired. […] They also can correct with surgery some speech problems that may arise in these children. […] Some children need only speech and language therapy, while others also may need a prosthetic appliance and/or surgery to correct their speech problems. […] Our cleft lip and palate team typically meets with children once a year. Some children will see their specialists more or less often as needed. Our team approach assures that your child gets the complete, coordinated care he or she deserves.

• #22 Cleft Lip and Cleft Palate | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/cleft-lip-and-cleft-palate

  Yes. The opening in the hard and/or soft palate is usually closed in one operation, though your child may need more than one procedure depending on his particular circumstances. Your treatment team will outline specific recommendations. […] Treatment for a cleft lip/cleft palate usually involves reconstructive surgery and several key support services. […] The Cleft Lip and Palate Program at Boston Children’s Hospital takes a multidisciplinary team approach to repairing your child’s specific cleft and addressing related conditions. […] A cleft palate is typically closed between the ages of 9 and 11 months, before a baby makes their first attempt to use words. Your child’s plastic surgeon will discuss the best repair plan for their needs and circumstances. […] Approximately five to 15 percent of all children who have undergone a cleft palate repair will need a second operation to correct nasal-sounding speech. These operations are often performed around 4 to 6 years old. A common procedure is called a pharyngeal flap, but other operations may be recommended based on your child’s anatomy. […] The follow-up care your child will need depends on the extent of his cleft lip and/or cleft palate. In our Cleft Lip and Palate Program, we see patients as frequently as every six months to every other year, from infancy all the way through adolescence.

• #23 Speech-Language Therapy for Children With Cleft Palate (for Parents) | Nemours KidsHealth

  https://kidshealth.org/en/parents/speech-therapy-cleft-palate.html

  Speech-language therapy is care that helps kids: improve speech, understand and use language, communicate in nonverbal ways (listening, taking turns, etc.) […] Speech-language pathologists help kids with speech disorders (like stuttering), hearing problems, feeding problems, and other medical conditions, including cleft palate. […] SLPs who work with children with cleft palate have extra training to recognize and treat specific problems caused by a cleft palate. Children born with a cleft palate may need speech-language therapy to help with problems such as: […] The main goals to help children with „cleft palate speech” are to: Establish correct articulation (placement, manner, and voicing) using articulation therapy techniques. Ensure there is good oral pressure during speech sound production. Establish new motor speech patterns that replace speech sound errors.

• #23 Speech-Language Therapy for Children With Cleft Palate (for Parents) | Nemours KidsHealth

  https://kidshealth.org/en/parents/speech-therapy-cleft-palate.html

  Speech therapy should begin as soon as possible. Children who start speech therapy early tend to have greater success. […] Support from parents is key to the success of a child’s progress in speech therapy. […] Your therapist should give homework for you and your child to do after each session. Helping your child complete these activities will ensure continued progress and carryover of new skills. […] The SLP should be certified by ASHA.

• #24 Speech Therapy for Children with Cleft Lip or Cleft Palate

  https://www.betterspeech.com/post/speech-therapy-cleft-palate

  […] […] Speech therapy can help with cleft lip and cleft palate […] During your first session, the pediatric speech-language pathologist (SLP) will ask you questions about your child. This includes your child’s medical history and motor development. They will also conduct a physical examination and a speech and language assessment. Based on this information, the SLP will develop a treatment plan tailored to your child’s individual needs. […] […] […] Speech-language therapy can help a child to: […] 1. Eat and drink without spilling […] 2. Make speech sounds correctly […] 3. Learn how to make all the speech sounds […] 4. Improve clarity of speech […] 5. Reduce drooling […] 6. Prevent or correct swallowing problems […] […] […] An untreated cleft palate can lead to serious health problems. This includes hearing loss, dental problems, and feeding difficulties. Early diagnosis and treatment are important for the best possible outcome. If you or your child have an untreated cleft palate, it can cause many problems. These include:

• #24 Speech Therapy for Children with Cleft Lip or Cleft Palate

  https://www.betterspeech.com/post/speech-therapy-cleft-palate

  1. Ear infections: The opening between the nose and mouth isn’t closed. Air can escape through it when a child breathes. An untreated cleft palate can cause ear infections. […] 2. Speech disorders: Children may have trouble making certain speech sounds, such as p, b, and m. Untreated cleft palate or cleft lip can cause lifelong speech disorders. […] 3. Dental problems: Children may have trouble brushing their teeth and flossing. This can lead to cavities and other dental problems. […] 4. Feeding problems: Children may have trouble feeding. They may have trouble sucking, and they may choke or gag when they eat. […] 5. Social problems: Children with untreated clefts may have social problems. This includes situations such as teasing from other children. […] If you think your child may have a cleft lip or palate, please contact your doctor. They can refer you to a speech-language therapist for an assessment. Together, we can help your child overcome any challenges they face and reach their full potential. Early diagnosis and treatment are important for the best possible outcome.

• #25 Supportive Treatment for a Cleft Lip or Palate

  http://healthlibrary.umcno.org/Conditions/Cancer/Tools/3,89827

  Be sure your child wears any prescribed spacers or guards as instructed. They help with normal mouth function. Your child will likely need to wear these dental appliances for the rest of their life. […] Cleft palate that affects the gum often causes teeth to grow in abnormally. Your child will likely need braces to straighten the teeth. Braces can be used to fix baby or adult teeth. Your child may also need to have their jaw fixed or have missing teeth replaced. […] Follow up with the pediatric dentist and orthodontist. Your child will need regular mouth care for the rest of their life. […] Speech therapy and swallowing […] Your child will likely begin speech therapy before surgery to repair the cleft lip or cleft palate. Therapy will continue after surgery. The speech pathologist will help your child relearn where to place the tongue, how to say words, and how to swallow, if needed. Expect your child to work with a speech pathologist until your child can speak well. Many children with cleft lip, cleft palate, or both, develop normal speech at about age 6 or 7 years old. But it varies, depending on the child and how severe the cleft was.

• #25 Supportive Treatment for a Cleft Lip or Palate

  http://healthlibrary.umcno.org/Conditions/Cancer/Tools/3,89827

  Emotional care […] Help your child cope with social and emotional issues. Explain to your child that other children tend to react poorly to differences. Reassure your child that they have done nothing wrong. […] Give your child a lot of positive feedback about their appearance. This will boost your childs self-esteem. Positive messages from loved ones also help your child face other peoples insensitive words and actions. […] Talk with your child’s teachers about your child’s cleft lip or palate. Ask the teacher what they can do in the classroom to help other children understand cleft lip or palate. If your child is old enough, ask your child how they would like the classroom situation managed. This will help ensure that your child has support in the classroom.

• #26 Treatment of Cleft Lip & Palate – Department of Pediatrics

  https://med.virginia.edu/pediatrics/clinical-and-patient-services/patient-tutorials/cleft-lip-palate/treatment-of-cleft-lip-palate/

  A cleft palate is initially treated with surgery. This is usually not done right after birth, but is delayed until the child is old enough and big enough for the surgery to be done safely. This is usually when the child is about 7-18 months old, but will depend upon the individual situation. For example, if the child has other health problems, surgery will most likely be delayed. […] The major goals of surgery are to: Close the gap or hole between the roof of the mouth and the nose, Reconnect the muscles that make the palate work, Lengthen the repaired palate so it can function properly. […] The choice of techniques should be discussed between the parents and the surgeon before the surgery. […] The child should be assessed at yearly intervals by a trained speech and language pathologist. Previous experience has shown that the vast majority of these children will require some speech therapy to train their palate muscles to work properly after surgery. Even with intense speech therapy, studies have shown that in about 1 out of every 4 children, additional surgery will be needed to further correct the palate enough to allow for proper speech production. […] Depending upon the severity of the cleft, some children will need orthodontic treatment to correctly line up their teeth, and some may need more surgery to replace the missing bone where the cleft splits the upper jaw bone.

• #27 Cleft Lip and Cleft Palate – Seattle Children’s

  https://www.seattlechildrens.org/conditions/cleft-lip-palate/

  Seattle Childrens clinical care pathway for cleft lip and palate guides your child’s care from diagnosis onward. […] Starting soon after birth, we regularly check your childs weight and growth. Parents often need help with feeding if their baby has a cleft. […] Cleft lip makes it hard for the baby to make a seal with their lips around the nipple. Most often, babies with cleft lip can be fed by breast or regular bottle. We can give you tips on how to hold your baby for better feeding. […] With a cleft palate, the baby cannot get enough suction to suck milk out of the breast or regular bottle. When they suck, the roof of their mouth does not close off the mouth from the nose. Babies with cleft palate usually need special bottles and nipples. We can help you understand the different types. We will teach you feeding techniques so your baby eats enough to grow and thrive.

• #28 Cleft Lip and Cleft Palate

  https://www.asha.org/public/speech/disorders/cleftlip/?srsltid=AfmBOoodCSAG_cg4u1w_Pz4oeQpp3iKxR2_LeoZlVMt_hzv-fhvTijkd

  Although cleft lip palate is often addressed with surgery and dental and orthodontic care, the medical team supports any additional feeding, speech, or hearing problems. […] SLPs work with people on feeding and swallowing skills. Babies with a cleft lip probably wont have trouble feeding, but babies with a cleft palate might. Babies with a cleft palate may have trouble breastfeeding, and they may need special bottles or nipples if they bottle-feed. SLPs can help you find the best bottle-and-nipple combination. Physicians and the rest of the team will also watch growth and nutrition. Learn more about feeding and swallowing problems in children and feeding and swallowing in adults. […] SLPs also work with people on speech problems. Cleft lip may not create any speech problems, but a person with cleft palate may need help learning to speak more clearly. […] Audiologists manage hearing and balance problems. The audiologist will work with the physician to make sure that hearing loss is identified and addressed, if needed. Audiologists may help you to use amplification (like hearing aids) or other hearing technology.

• #29 Cleft Lip and Cleft Palate Treatment Options

  https://www.kidsplastsurg.com/cleft-lip-palate/treatment-options/

  To repair a cleft lip, the surgeon will make an incision on either side of the cleft from the mouth into the nostril. The goal in lip repair is to create a structure of normal appearance and function. […] Repair of the palate is directed at producing normal speech, restoring Eustachian tube function, attaining closure of oronsasal fistulas, and minimizing alterations in maxillary growth. […] To repair a cleft palate, the surgeon will make an incision on both sides of the separation, moving tissue from each side of the cleft to the center or midline of the roof of the mouth. This rebuilds the palate, joining muscle together and providing enough length in the palate so the child can eat and learn to speak properly. […] Children with clefts including the alveolar dental arch will require bone grafting to maintain the dental arch and allow the ingrowth of teeth immediately adjacent to or within the cleft.

• #30 Cleft Palate Treatment – Little Silver NJ | Two River Orthodontics

  https://www.tworiverortho.com/cleft-palate-treatment

  A child born with a cleft frequently requires several different types of services, e.g., surgery, dental/orthodontic care, and speech therapy, all of which need to be provided in a coordinated manner over a period of years. This coordinated care is provided by interdisciplinary cleft palate/craniofacial teams comprised of professionals from a variety of health care disciplines who work together on the childs total rehabilitation. […] A cleft lip can usually be repaired in the first few months of life. A cleft palate can usually be repaired some months later. The exact timing of these repairs depends on the babys health and considerations of his or her future development, as determined by the doctor who performs the surgery. […] Many children with cleft palate need the help of a speech pathologist, and some may need an additional operation to improve their speech. The goal is to help the child develop normal speech as soon as possible. […] Modern care of a child born with a cleft lip or cleft palate is best managed by a team of medical, dental, speech, and other specialists.

• #31 Cleft Lip/Cleft Palate | Birth Defects | CDC

  https://www.cdc.gov/birth-defects/about/cleft-lip-cleft-palate.html

  Surgery to repair a cleft lip usually occurs in the first few months of life. It is recommended within the first 12 months of life. […] Surgery to repair a cleft palate is recommended within the first 18 months of life, or earlier if possible. Many children will need additional surgical procedures as they get older. […] Surgical repair can help restore function to the lips and mouth. It may help improve breathing, hearing, and speech and language development. Children born with orofacial clefts may also need special dental or orthodontic care or speech therapy. […] With treatment, most children with orofacial clefts do well and lead a healthy life. Some children may have issues with self-esteem if they are concerned with visible differences between themselves and other children.

• #32

  https://www.nhs.uk/conditions/cleft-lip-and-palate/

  Cleft lip and cleft palate are treated at specialist NHS cleft centres. […] Your child will usually have a long-term care plan that outlines the treatments and assessments they’ll need as they grow up. […] The main treatments are: surgery an operation to correct a cleft lip is usually done when your baby is 3 to 6 months and an operation to repair a cleft palate is usually done at 6 to 12 months […] feeding support you may need advice about positioning your baby on your breast to help them feed, or you might need to feed them using a special type of bottle […] monitoring hearing a baby born with cleft palate has a higher chance of glue ear, which may affect hearing. Close monitoring of their hearing is important and if glue ear affects their hearing significantly, a hearing aid may be fitted or small tubes called grommets may be placed in their ears to drain the fluid

• #32

  https://www.nhs.uk/conditions/cleft-lip-and-palate/

  speech and language therapy a speech and language therapist will monitor your child’s speech and language development throughout their childhood and help with any speech and language problems […] good dental hygiene and orthodontic treatment you’ll be given advice about looking after your child’s teeth, and they may need braces if their adult teeth don’t come through properly.

• #33 Center for Cleft Lip, Palate and VPI

  https://pediatrics.northwell.edu/departments-services/center-for-cleft-lip-palate-vpi

  During the surgery, the muscle in the roof of the mouth is repaired, allowing for normal speech by sealing off the nose from the mouth during muscle contraction. In some cases, a follow-up surgery is required to improve speech. […] All children with cleft palate are referred to our experts in pediatric otolaryngology for consultation for possible ear tubes, called myringotomy tubes. These tubes are placed at the time of surgery for cleft palate repair. […] Surgical repair involves reconstruction of the muscle to allow for proper closure of the nose during feeding and speech and is often performed around 11 months of age. Children are kept in the hospital for observation overnight. […] Velopharyngeal insufficiency (VPI) occurs when the soft palate cannot properly close during speech, allowing air to escape through the nose instead of the mouth. This may lead to very nasal speech and make it hard for people to understand your child when he or she is speaking. […] If indicated, surgery can be performed to help close off the connection and improve speech.

• #34 Cleft Lip & Palate | Children’s Hospital Colorado

  https://www.childrenscolorado.org/conditions-and-advice/conditions-and-symptoms/conditions/cleft-lip-and-palate/

  Cleft conditions occur in many variations and require different treatment options based on how they manifest. […] At Children’s Colorado, treatments are determined on an individual basis and care starts with a visit to the Cleft Lip and Palate Program. […] Currently, there are no treatments available for unborn babies with cleft lip and cleft palate conditions, which is why surgeons repair clefts after birth. […] Once the timeline and treatment plan are decided, treatments may include: Nasal alveolar molding appliance (NAM) is a type of orthodontics used to treat infants with cleft lip and palate. […] Mandibular distraction osteogenesis (MDO) treats a condition known as micrognathia/retrognathia (a symptom of Pierre Robin Sequence), which means a small jaw. […] Tympanotomy surgery creates a small opening for placement of an ear tube. Approximately 90% of children with cleft palate will require tympanotomy and ear tube(s). […] Additional cleft lip and palate surgeries include: Speech surgeries, Cleft lip and/or palate revision(s), Nasal surgery, Bone grafting, Jaw surgery. […] For over 45 years, Children’s Colorado has been a top treatment center in the country for children with cleft lip and palate.

• #35 Pediatric Cleft Lip and Palate Surgery

  https://www.arnoldpalmerhospital.com/pediatric-specialties/pediatric-cleft-lip-and-palate-surgery

  A cleft palate or cleft lip is one of the most common birth defects that can occur in a child. And while they may feel scary and overwhelming at first, remember its a highly treatable condition that can be corrected with surgery. […] Your childs cleft care will be coordinated through the cleft palate team with visits about once per year. Surgical care for structural defects at the lip and nose, jaw or palate are most often performed in stages based on your childs growth and development. Speech and language therapy or orthodontic therapy are frequently required, as are regular dental and hearing care. […] Cleft lip repair (first surgery) […] Cleft palate repair (second surgery) […] Closely monitor speech and language development and manage velopharyngeal insufficiency (hypernasal speech) with surgery prior to school age, when needed […] Lip and nose revision surgery prior to school age, when needed […] Jaw surgery when needed […] Rhinoplasty when needed.

• #36 Cleft Lip & Palate Treatment Options | New York Eye & Ear

  https://www.nyee.edu/care/ent/facial-plastic-surgery/cleft-lip-palate/treatment

  10 Weeks: Experts may perform cleft lip repair and cleft nose repair, and insert ear tubes. […] 9 Months to One Year: Experts may perform cleft palate repair. […] 3-5 Years: Experts may provide speech therapy and adjunctive surgical procedures. […] 10-14 Years: Experts may perform bone grafting for Alveolar clefting. […] 14-17 Years: Experts may perform cleft rhinoplasty for definitive nasal repair when necessary.

• #37 Cleft Lip and Palate: Causes, Symptoms, Diagnosis, Treatment

  https://www.webmd.com/oral-health/cleft-lip-cleft-palate

  Surgery to close a cleft palate happens during the baby’s first year. The surgeon closes the opening in the palate and rebuilds the roof of the baby’s mouth. Special tubes may go into the child’s ears to drain fluid and prevent hearing loss. […] Other treatments […] Your child’s doctor may suggest one or more of these treatments to fix complications from a cleft lip and palate: […] Speech therapy […] Treatment for a cleft lip and cleft palate can take many years and involve several surgeries. But most children with this condition can have a normal childhood and life.

• #38 Cleft lip and cleft palate – Wikipedia

  https://en.wikipedia.org/wiki/Cleft_lip_and_cleft_palate

  Cleft palate can also be corrected by surgery, usually performed between 6 and 12 months. […] If the cleft extends into the maxillary alveolar ridge, the gap is usually corrected by filling the gap with bone tissue. […] Each person’s treatment schedule is individualized. […] The current model for delivery of this care is the multidisciplinary cleft team.

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