Cleft Lip and Cleft Palate Diagnosis and Treatment
OHSU Doernbecher Children’s Hospital treats more cleft lips and cleft palates than any other hospital in Oregon. We provide complete care for your child’s speech, hearing, appearance, emotional well-being and more.
- Our state-of-the-art, 3D ultrasound makes detailed images of your child’s cleft before birth, helping you prepare for treatment.
- We are the only hospital in Oregon to offer Nasoalveolar Molding (NAM), a treatment before cleft lip or palate surgery that helps improve results.
- Our team can perform cleft lip surgery using the Millard procedure, a new technique that gives the affected tissue more flexibility.
- We work with you to find dentists and orthodontists in your community skilled at meeting your child’s oral health needs.
Diagnosing cleft lip and cleft palate
Care for your child’s cleft lip or palate depends on the type of cleft and when it is diagnosed. OHSU offers resources to guide your family as you prepare for a baby with a cleft.
You are likely to learn that your baby has a cleft lip before birth. A cleft lip can be seen on a 3D prenatal ultrasound.
A cleft palate is rarely diagnosed before birth, because an ultrasound can’t show the inside of your baby’s mouth. After birth, your child’s provider will check their palate for signs of a cleft.
Treatment for cleft lip/palate
Our team includes many specialists who will work together to give your child the best possible care for their condition.
Our expertise includes:
- Plastic and craniofacial surgery
- Oral surgery
- Otolaryngology (ear, nose and throat)
- Social work
- Speech/language pathology
- Pulmonology (lung and respiratory conditions)
- Ophthalmology (eye and vision care)
- Physical therapy
- Advanced healthcare (nurses, nurse practitioners, physician assistants)
We will support your child and family throughout treatment and recovery. Our nurse coordinator will answer all your questions, help you schedule appointments, and help you find support and resources.
If your child is diagnosed with a cleft lip before birth, you will meet with a nurse practitioner right away to outline the path ahead.
This prenatal meeting takes about one hour. You will talk about what to expect, learn how to feed your baby if they can’t nurse, and receive custom bottles for feeding. We will offer counseling and screening for genetic disorders.
You and your baby will meet with your care team within the first few weeks of life if your child has a cleft.
This full-day meeting will include your reconstructive surgeon, a nurse practitioner, an orthodontist, and a social worker. If your baby’s hearing may be affected, you will meet with a hearing specialist too.
We will take photographs of your child’s cleft and talk about plans for surgery in three to five months. We may show you how to tape your child’s lip to narrow the cleft before surgery.
Nasoalveolar Molding (NAM)
This treatment, done before surgery, can help improve the shape of the lip and nose in some cleft cases.
No other hospital in Oregon offers NAM. Our orthodontic team has advanced training in the technique. If the procedure is right for your child, we will install an appliance similar to a dental retainer that your child will wear until the surgery. This treatment requires frequent clinic visits to adjust the appliance weekly or every other week.
Our speech pathologists will evaluate your child regularly. For cleft palate, speech therapy can help your child develop sounds even before their cleft repair.
Speech therapy can help your child develop sounds, then words or phrases. The speech pathologist will teach you techniques to help your child’s speech develop at home. Our goal is to help your child build language skills, learn to speak clearly, and develop a clear and resonant voice.
Up to 30% of children with cleft palates develop velopharyngeal dysfunction (VPD). This occurs when the soft palate does not separate the nose from the mouth. This lets air escape through the nose, making speech difficult. For children with VPD, we may recommend a speech appliance or surgery.
Cleft lip surgery
Cleft lip surgery usually happens at 3 to 5 months old. Your child will be asleep (under general anesthesia) and will feel no pain during the surgery.
Your child’s surgeon will reconstruct the areas of your child’s nose, mouth and face that are affected by the cleft.
The surgery will last several hours. You can join your child as soon as they arrive at the recovery room.
In many cases, your child will be able to go home the same day. We will give you padded arm restraints to keep your baby from touching their face. Stitches will either dissolve or be removed within a few days.
Cleft palate surgery
Cleft palate surgery usually happens at 12 months old. Your child will be asleep (under general anesthesia) and will feel no pain during the surgery.
Your child’s surgeon will reposition the affected tissues and muscles, then close the separation in the roof of the mouth and rebuild the palate. The surgeon may also fit your child with tiny ear tubes to reduce the risk of ear fluid building up.
The surgery will last several hours. You can join your child as soon as they arrive at the recovery room. In most cases, your child will be able to go home the next day.
We may recommend medication for pain relief for up to two weeks after surgery.
Some babies return easily to feeding, but others take time to adjust. Before you take your child home from the hospital after surgery, we will make sure you are able to feed well at home.
During healing, you will need to keep the scar clean and watch for signs of infection. For cleft lip, you can ask your care team about using creams or oils on the scar after it heals.
During and after recovery, we will meet with you and your child every six months. Our specialists are all available on Mondays so your family can make multiple appointments on one day. Our team meets weekly to make sure each patient gets the best possible ongoing care.
Our team will create a follow-up plan just for your child to help with any speech, feeding, breathing or hearing issues. We will help you find a dentist in your community who is skilled in follow-up care for cleft lip and cleft palate.
Depending on your child’s needs, these appointments may end after a few years or continue into your child’s teens.
Over time, we may recommend other surgeries, including:
- Speech surgery: Surgery at age 4 to 8 can help improve speech for children with cleft lips.
- Alveolar bone graft: A surgery at age 8 to 10 to attach bone to the gum line.
- Cleft lip follow-up: Surgery in the early teens, when the face is fully developed, to reduce scarring and improve appearance.
- Nose/jaw follow-up: Surgery in the teen years, to improve nose or jaw function or appearance.
Along with speech therapy, we may recommend dental or orthodontic treatment. Some children benefit from counseling to help with emotional issues related to their condition.
Our team is a source of care and connection to any follow-up services your child needs.
Support services for cleft lip and cleft palate
Prenatal support: Following your child’s diagnosis, we will connect you to the OHSU Doernbecher Fetal Care Program, the only comprehensive program of its type in Oregon. A team of specialists in neonatal care, maternal-fetal medicine and pediatrics can help you prepare for your child’s birth.
Social services: OHSU’s craniofacial team includes a specialist who works with children and families to address social issues like teasing or bullying about physical differences.
Housing and transportation: Our team can help you arrange transportation to OHSU, including help with medical travel for Medicaid patients who live more than 50 miles away. We can provide vouchers for reduced costs at nearby hotels if your family needs to stay overnight.
Language assistance: We provide translators to help families whose first language is not English.
- ACPA Family Services: Resources for Your Cleft Journey, American Cleft Palate-Craniofacial Association
- Medical Cleft Resource Library, SmileTrain
- Cleft Lip and Cleft Palate, American Speech-Language-Hearing Association
Call 503-346-0640 to:
- Request an appointment
- Seek a second opinion
- Ask a question
Parking is free for patients and their visitors.
Doernbecher Children’s Hospital
700 S.W. Campus Drive
Portland, OR 97239
Map and directions
Find other locations across Oregon and in southwest Washington.
For referring providers
Refer your patient to OHSU Doernbecher.
Call 503-346-0644 to:
- Seek provider-to-provider advice.
- Request education about plagiocephaly or other conditions.