In short. Who is involved in cleft care — surgeons, nurses, speech therapists, audiologists, dentists and orthodontists — and roughly when each step of the sequence happens.
Key points
- The order is not arbitrary.
- The palate is closed before speech is learned, because a repaired palate is what allows a child to build normal speech patterns from the beginning.
- Bone grafting waits until the adult teeth are ready to come down into the graft.
A cleft is not repaired by one specialist. It is managed by a team, because a cleft affects feeding, hearing, speech, the growth of the face, and the arrangement of the teeth, and no single discipline covers all of that. International guidance is consistent that children with clefts do best when their care is coordinated by a multidisciplinary team rather than assembled piece by piece.
Who is on the team
A cleft team typically brings together a reconstructive or plastic surgeon, a specialist cleft nurse, a speech and language therapist, an audiology and ear, nose and throat service, a paediatric dentist, an orthodontist, a paediatrician, a clinical geneticist, and a psychologist or social worker. Not every child needs every member every year. What matters is that they all look at the same child with the same plan.
Roughly when each step happens
Timing varies with the child, the type of cleft, and the treating centre, but the shape of the sequence is well established. Hearing is tested in the newborn period and reviewed through early childhood. Lip repair is usually performed in the first three to six months. Palate repair usually follows between about nine and eighteen months, before speech is fully established. Speech is monitored from the toddler years. Dental and orthodontic review runs through childhood, and bone grafting to the gum, where needed, is typically done around six to ten years as the adult canine tooth develops. A final orthodontic phase often runs through the teenage years.
The idea behind the sequence
Each step makes the next one possible
The order is not arbitrary. The palate is closed before speech is learned, because a repaired palate is what allows a child to build normal speech patterns from the beginning. Bone grafting waits until the adult teeth are ready to come down into the graft. Orthodontics may prepare the arch before grafting and finish the alignment afterwards. Doing the right operation at the wrong time is often worse than waiting.
What the team asks, and what it cannot promise
Care that spans years works only if families stay involved: keeping review appointments even when nothing seems wrong, following feeding and repair-care advice closely, and raising concerns about speech or hearing early rather than waiting for the next visit. A team can only coordinate what it knows about. It also does not make cleft care effortless. Appointments are frequent, travel can be demanding, and there will be periods, usually around a planned operation, when the process feels like a great deal to carry. No sequence guarantees a particular result.
Contact the team promptly if
- You miss a review appointment, or the next step is many months away and you are unsure why.
- Your child develops new speech difficulties, or speech that was clear begins to sound nasal.
- There is discharge from an ear, ear pain or fever, or you suspect your child is not hearing well.
Frequently asked questions
Who is on a cleft team?
Typically a reconstructive or plastic surgeon, a specialist cleft nurse, a speech and language therapist, an audiology and ear, nose and throat service, a paediatric dentist, an orthodontist, a paediatrician, a clinical geneticist, and a psychologist or social worker. Not every child needs every member every year, but they follow one plan.
When does each step of cleft care happen?
Hearing is tested in the newborn period. Lip repair is usually done in the first three to six months. Palate repair follows between about nine and eighteen months, before speech is fully established. Bone grafting to the gum is typically done around six to ten years, and orthodontics often runs through the teenage years.
Why does the order of cleft treatment matter?
Because each step makes the next possible. The palate is closed before speech is learned, because a repaired palate lets a child build normal speech patterns from the beginning. Bone grafting waits until the adult teeth are ready to come down into the graft. Doing the right operation at the wrong time is often worse than waiting.
Risks & Limitations
- Cleft care spans years and usually several operations. A single procedure does not finish it, and the plan may change as a child grows.
- Scars from lip and nasal repair are permanent. They fade and soften, but they never disappear.
- Speech may still need therapy, or further surgery for velopharyngeal insufficiency, after palate repair.
- Hearing problems and repeated ear infections are common, and may need ventilation tubes and long-term ear review.
- Feeding difficulties before and after repair, including slow feeds and poor weight gain.
- Dental and orthodontic problems: missing, misplaced or crowded teeth, and a bite that needs years of treatment.
- Growth disturbance of the upper jaw, which may require later revision or corrective jaw surgery.
- No outcome is guaranteed. Perfection is not achievable and is not the goal.
When to Seek Care
- A baby who cannot feed, coughs or chokes during feeds, or is losing weight or not gaining it.
- Difficulty breathing, noisy breathing, or pauses in breathing, especially after palate repair.
- Fever with a repair site that is red, hot, swollen or discharging.
- Bleeding from a lip or palate repair that does not stop with gentle pressure.
- Fluid or discharge from the ear with pain or fever, or any suspected change in hearing.
References & Further Reading
- American Cleft Palate-Craniofacial Association (ACPA) — parameters and team care guidance
- World Health Organization (WHO) — congenital anomaly and child health resources
- Cochrane Library — systematic reviews in cleft lip and palate care
- Chinese Medical Association, Plastic Surgery Branch — clinical guidance
This page is patient education, not medical advice, and it does not cite individual studies. Discuss your own case with a qualified clinician. To arrange an assessment at Chongqing West District Hospital, see Contact & Consultation.