Alaska Native Medical Center

Many cleft lip and palate concerns are identified before the baby is born,
however, cleft lips and palates have many appearances and may not be
diagnosed until after birth. In these cases, signs may include facial
difference, feeding difficulty, including fluid coming out of the nose,
and failure to gain weight.

When an OBGYN provider identifies a cleft lip or palate concern, the medical
director of the facility where you are being seen will be notified. After the medical
director confirms the diagnosis of a cleft lip or palate, they will write a referral
to the Alaska Cleft Lip and Palate Program at SCF. Once that referral is received, a
member of the team will reach out to meet with you and discuss what will happen after
your baby is born.

Congratulations! Being a new parent is an exciting time, but can also be
stressful if your baby is born with a cleft lip or palate. Alaska’s Cleft Lip and
Palate Program at SCF is here to help with what will happen next.

Once your baby is born, a doctor from the team will check in at the hospital
to ensure your baby is able to feed properly. The doctor will also check in
with you to ensure you are feeling ready to help your baby grow and take care
of your child.

Every child is different, and the severity of the cleft will affect the course
of action the doctor recommends. By the time your baby is born, you should already
have a relationship with an Alaska Cleft Lip and Palate Program team member who
will help guide you through the next steps.

Team evaluations happen at the Alaska Cleft Lip and Palate Program at SCF six times a year, or about every two months. If you and your doctor have not already scheduled the first corrective surgery to address your baby’s cleft, this will occur at the team evaluation. During these evaluations, you will also meet with an audiologist, a speech language pathologist, an ear, nose and throat professional, a plastic surgeon, a nutritionist, pediatrician, pediatric dentist, and the parent navigator. Some families may meet with an oral surgeon and orthodontist, and a behavioral health consultant.

At the first team evaluation, you and your providers will set a long-term plan of treatment. Treatment plans generally include a rough time frame for surgeries, suggestions for therapy including speech therapy, suggestions for pediatric follow-up, and recommendations for further interval evaluations such as for hearing. We will also establish a time frame for re-evaluation by the entire multidisciplinary cleft lip and palate team.

Once the team evaluation has been completed, all the recommendations will be sent to your primary care provider. It will be up to you and them to decide what happens next.

The number of surgeries depends in large part on what is affected by the cleft. For instance, children with a complete cleft lip and palate typically require surgery to repair the lip between 4-6 months of age, a palate repair between 9-16 months of age, and bone grafting to the gum line between 7-9 year of age. Some of these children will require revision of the lip for poor scarring and additional surgical procedures to help with speech. Depending on the severity of the cleft and on growth of the child, jaw surgery (orthognathic surgery) may be required to modify the shape of the face and better align the teeth around 17-22 years of age. Septorhinoplasty (nose revision surgery) to correct any lingering nasal deformities is also performed after the face has matured, usually happens between 16-22 years of age

Your family provider can refer you to a feeding specialist in your community. Feeding evaluations also occur as part of your team visit if reported as an ongoing concern by your or your family provider.

If your child is found to have hearing loss, treatment in the form of a hearing aid or aids may be recommended. If hearing aids are not covered by your insurance, they will typically be covered by Medicaid. Fitting hearing aids on your child will be performed by an audiologist.