Staged repair of cleft lip and palate from infancy, with feeding, speech, hearing and dental care planned around the child’s growth.
A cleft lip is a gap in the upper lip and a cleft palate a gap in the roof of the mouth. Both form before birth, when structures that normally join together do not fuse. Surgery closes them in stages during infancy, and further procedures may follow as the child grows, because the face keeps developing long after the first repair.
The upper lip fuses at about the sixth week of pregnancy and the palate at about the ninth to twelfth week. If that fusion is incomplete, a cleft remains. It can involve the lip alone, the palate alone, or both. A cleft lip may be on one side or on both, and may extend into the nostril or stop short of it. Nothing the mother did or did not do during pregnancy causes it, and parents are told this plainly, because the guilt is often heavier than the condition.
The practical effects go well beyond appearance. A baby with a cleft palate cannot generate suction, so feeding is difficult and milk may come back through the nose. Fluid collects behind the eardrum more often, which affects hearing. Air escapes through the nose during speech, giving a nasal quality that does not correct itself. Teeth in the line of the cleft may be missing, extra or rotated. Each of these is managed by a different member of the team, which is why cleft care is organised as a programme rather than a single operation.
Lip repair is usually done at around three to six months of age, once the baby is feeding and gaining weight reliably. Surgeons have long used a rough guide of ten weeks of age, ten pounds in weight and a haemoglobin of ten, which is a way of saying the child must be well enough for anaesthesia rather than a fixed rule. Palate repair follows at roughly nine to eighteen months, timed before speech develops, because the palate has to work for normal sounds to form.
Later stages are spaced across childhood. Where the cleft crosses the gum, a bone graft is usually placed at around eight to eleven years, timed to the development of the permanent canine tooth so that it has bone to erupt into. Surgery to the nose and, in some children, to the jaws is left until growth is complete in the teenage years, because operating earlier can be undone by the growth still to come. Parents are given this whole map at the start rather than one step at a time.
Cleft care needs a plastic surgeon, a paediatrician, a paediatric anaesthetist, an ENT surgeon, a speech therapist, an orthodontist and a dentist, and it needs them at different points over fifteen years. Before the first operation the priority is feeding and weight gain, with guidance on positioning and specialised teats. After palate repair the priority shifts to speech, and therapy is not optional; surgery makes normal speech possible but does not by itself produce it.
Hearing is checked repeatedly through childhood, and some children need grommets. Orthodontic treatment usually begins in the mixed dentition years and continues into the teens. Follow up is long by design, and families are asked to plan for a relationship with the unit rather than a single admission.
| Factor | What it covers |
|---|---|
| Type of cleft | Lip only, palate only or both, and one side or two |
| Number of stages | Most children need more than one operation across childhood |
| Age and fitness for anaesthesia | Paediatric anaesthesia and monitoring for a small child |
| Hospital stay | Usually a few days for each stage |
| Speech therapy | Sessions over months after palate repair |
| Orthodontic and dental care | Alignment, bone grafting and missing teeth |
| Later revision | Nose or jaw surgery once growth is complete |
These pages answer the questions that most often come up alongside this one.
It depends on the type of cleft and the number of stages, since most children need more than one operation across childhood. An estimate is given for each stage once the plan is set, covering surgery, paediatric anaesthesia, hospital stay and follow up. Several government schemes in India support cleft care for children, and the hospital team helps families check eligibility.
Usually between three and six months, once the baby is feeding well and gaining weight. The old guide of ten weeks, ten pounds and a haemoglobin of ten is really a way of saying the child must be fit for anaesthesia, and that judgement is made by the paediatrician and anaesthetist together.
The palate is repaired at around nine to eighteen months so that it is working before the child begins to form words. Repairing it at the same time as the lip is not usual, because the two operations have different aims and the palate repair is timed to speech rather than to appearance.
Many children do, but surgery makes normal speech possible rather than guaranteeing it. Speech therapy after palate repair is a central part of the treatment, and a proportion of children need a further procedure later if air continues to escape through the nose. This is assessed rather than assumed.
A baby with a cleft palate cannot create suction, so feeding needs specialised teats, an upright position and patience. The team gives this guidance at the first visit, because steady weight gain is what makes the first operation possible.
There will be a scar on the lip. It is placed along the natural lines of the lip and philtrum so that it settles into them, and it fades considerably over the first year or two. Scar care, sun protection and in some children a later revision all affect how it finally looks.
In most children no single cause is found. Genetic factors, family history and events in early pregnancy all contribute, and a cleft is sometimes part of a wider syndrome, which is why the paediatrician examines the whole child. Families who want a figure for recurrence in a future pregnancy are referred for genetic counselling rather than given a guess.
Usually a few days for each stage. Feeding and pain control are the two things that decide when a child goes home, and parents are shown how to manage both before discharge.
Published with written patient consent and shown for education rather than promotion. Every case is different and these images are not a promise of results.
Consultations at Kiran Hospital, Katargam, Surat. Outstation and NRI patients can request a video consultation before travelling.