Children's Hospital Colorado

Cleft Lip/Cleft Palate

What is a cleft lip or cleft palate?

A cleft is an opening. Babies diagnosed with a cleft have an opening in the lip, roof of the mouth (palate) or both. Cleft conditions occur during the first three months of pregnancy when the tissue of the lip and palate do not fuse together completely. 

Cleft conditions occur in many variations. The Clinic team at Children's Colorado has the experience to treat all forms of cleft lips and cleft palates. Here are the most common forms of cleft lips/palates:

Types of cleft lips

  • Unilateral: on one side 
  • Bilateral: on both sides 
  • Complete: extends all the way into the nostril
  • Incomplete: does not extend up into the nostril
  • Isolated: cleft lip without a cleft palate

An artist's drawing of the bottom half of a baby's face. The upper lip extends only part of the way up to the nose on the right side only.An artist's drawing of the bottom half of a baby's face. The upper lip on the left side extends all the way up to the nose while the right side extends only partway up to the nose.

An artist's drawing of the bottom half of a baby's face. The upper lip extends up to the nose on the right side only.An artist's drawing of the bottom half of a baby's face. The upper lip extends up to the nose and there is a line to it that says Premaxilla.

Types of cleft palates (opening at the roof of the mouth)

  • Alveolar: a cleft in the upper gum line (alveolus) that may or may not extend into the cleft palate
  • Submucous: a cleft in the soft palate near the back of the roof of the mouth that is covered by a thin layer of skin or tissue; this type of cleft is often hard to diagnose because it’s not easily seen
  • Complete: extends from the front all the way to the back of the palate
  • Incomplete: does not extend all the way through the hard and soft palates
  • Isolated: a cleft palate without a cleft lip

An artist's drawing of a baby's open mouth. In the back of the mouth, the flesh is disconnected and there is a line to the part in the middle that says Premaxilla.An artist's drawing of a baby's open mouth. In the back of the mouth, the flesh is disconnected in the middle.An artist's drawing of a baby's open mouth. In the back of the mouth, the flesh is disconnected and has a wide gap.An artist's drawing of a baby's open mouth. In the back of the mouth, the flesh is thick and connected and there is a line to the part in the middle that says Zona pellucida and a line to the flesh hanging down in the middle that says Bifid uvulva.

What causes a cleft lip or cleft palate?

In most cases, the exact cause of a cleft is unknown. Most children born with a cleft lip and/or cleft palate don't have other medical conditions. However, some children may have additional medical conditions that are associated with a specific syndrome.

Experts believe a combination of genetic and environmental factors cause cleft conditions. A family history of cleft conditions may play a role in a child being born with a cleft. Certain behaviors and conditions may increase the risk of a cleft, including smoking during pregnancy, diabetes and the use of certain medications.

Who gets a cleft lip or cleft palate?

Clefts occur in all races and in both males and females. Cleft lip/palate is more common in Asian, Latino and Native American ethnicities than in other ethnic groups. Cleft lip and palate occurs about twice as often in boys as in girls, while an isolated cleft palate is slightly more common in girls. In the United States, clefting occurs once in every 650 -700 births and is one of the most common birth defects.

What challenges or other problems may a child with a cleft lip and/or cleft palate experience?

A cleft can affect appearance, feeding, speech, hearing and teeth. A child with a cleft may also experience social challenges. The cleft lip and palate team at Children’s Hospital Colorado offers support and education to help patients and families face these challenges from childhood to adulthood. As your child grows, resources for success in school and beyond are available at the Cleft Lip and Palate Clinic. 

Helpful resources

More information about Cleft Lip and Palates is available on the family resources page.

View pictures of cleft lip repairs before and after surgery

How is a cleft lip or cleft palate diagnosed?  

Today, approximately 30% of cleft lips are diagnosed prenatally by ultrasound. For families with a prenatal diagnosis, prenatal counseling is available. In counseling, you will discuss what to expect during the newborn period, feeding challenges, psychosocial issues, possible surgeries, speech and hearing assistance and dental work.

Sometimes, due to positioning, a baby’s face is difficult to see on an ultrasound. In these cases, a doctor diagnoses a cleft after birth with a physical exam in the nursery.

For more information, or to make a prenatal counseling appointment, call the Cleft Lip and Palate Clinic at 720-777-2574. Prenatal counseling is also available through the Colorado Fetal Care Center.

How is cleft lip/cleft palate treated?

Children born with cleft conditions often face complex health issues. Experience shows that a multidisciplinary team of specialists best manages these issues. Learn more about our care team.

At Children’s Hospital Colorado, treatments are determined on an individual basis and care starts with a visit to the Cleft Lip and Palate Clinic

Typical timeline of procedures and care

Currently, there are no treatments available for unborn babies with cleft lip and cleft palate conditions, which is why surgeons repair clefts after birth. After a visit to the Clinic, the team will develop a unique course of care with your family. Below, the timeline shows the typical timing of procedures and therapies included in treatment plans. Together, parents and the team at Children’s Colorado will decide the best course of treatment.

Click the appropriate age group or download the full timeline (.png).

Birth to 18 months old

Birth to 3 years old
Early intervention program

1 to 3 months old
First visit to Cleft Clinic
Nasal alveolar molding (NAM)
Occupational Therapy /feeding evaluation

3 to 6 months old
Lip repair, possible ear tubes; Ear tubes may be necessary more than one time; if placed, follow up with an ear, nose and throat specialist every six months.

6 to 15 months old
Hearing test; complete a hearing test every year
Pediatric dentist; visit the dentist at 12 months and every six months after.

15 to 18 months old
Palate repair, possible ear tubes
Genetics evaluation
Speech therapy evaluation
Second visit to the Cleft Lip and Palate Clinic

2 to 5 years old

Speech therapy
Possible lip / nose revision surgery
Annual visits to the Cleft Lip and Palate Clinic

6 to 12 years old

Secondary speech surgeries
Alveolar bone graft
Annual visits to the Cleft Lip and Palate Clinic

8 to 18 years old
Kids attend Cleft Camp
Developmental screening, as needed
Annual visits to the Cleft Lip and Palate Clinic

13 to 18 years old

Orthognathic (jaw) surgery
Secondary speech surgeries
Dental and orthodontics
Septoplasty/Rhinoplasty (nasal) surgery
Annual visits to the Cleft Lip and Palate Clinic

18+

Septoplasty/Rhinoplasty (nasal) surgery
Genetics counseling; at reproductive maturity
Transition to adult care provider

Explanation of procedures performed at the Cleft Lip and Palate Clinic

Once the timeline and treatment plan is decided, treatments may include:

Nasal alveolar molding appliance (NAM) is a type of orthodontics used to treat infants with cleft lip and palate. A trained pediatric dentist makes the appliance specifically for an infant. Infants wear this daily until the primary cleft lip repair surgery. The appliance looks like a mouth retainer.

NAM is used to move the gum segments closer together. The process requires weekly doctor visits to monitor the movement of the gum and lip segments. At the end of the process, the nose is shaped to give it a more natural appearance.

Mandibular distraction osteogenesis (MDO) treats a condition known as micrognathia/retrognathia (a symptom of Pierre Robin Sequence), which means, a small jaw. This condition can cause difficulties with breathing and feeding.

Mandibular distraction osteogenesis lengthens the jaw. By moving the jaw forward, the tongue and structures at the back of the throat move forward to open the airway. Opening the airway may help to relieve airway obstruction and improve feeding.

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

Why choose Children's Hospital Colorado for cleft conditions?

For over 45 years, Children’s Colorado has been a top treatment center in the country for children with cleft lip and palate. We are the largest clinic in the Rocky Mountain region, bringing together the benefits of comprehensive care, teaching and research.

At the Cleft Lip and Palate Clinic, we care for the “whole” child – inside and out. We offer additional activities and social outlets for cleft patients, including camps, bowling parties and holiday parties. We’ve found that these activities give children and teens the opportunity to spend time with others who share similar diagnoses and experiences, often resulting in new friendships and enhanced self-esteem.

The pediatric experts at Children's Colorado treat all aspects of cleft conditions. We have 11 pediatric specialties involved in establishing treatment plans for our patients. Our multidisciplinary team and exceptional outcomes have earned us the American Cleft Palate-Craniofacial Association endorsement.

Contact us

To reach the Cleft Lip and Palate Clinic, please contact us at the following phone numbers:

For appointments and questions in the Denver-metro area, please call 720-777-2574.
For appointments and questions in the Colorado Springs area, please call 719-305-9575.


Related departments

Children's Colorado in the news

KRDO News13 Colorado Springs

Cleft Lip and Palate Patients Come Together to Find Community

Cleft lip and palate patients gathered for a summer picnic. The event brought together patients from around the southern Colorado region.

The Gazette

New X-ray Machine Makes Colorado Springs Cleft Palate Clinic a One-stop-shop

The Colorado Springs Gazette featured our ribbon cutting ceremony for the new Panorex X-ray imaging technology machine at the Colorado Springs Cleft Clinic. Team members, patients and families gathered to celebrate the new addition, which will help cleft patients in southern Colorado and regionally who travel to receive care.


PRODWEBSERVER2