Cleft lip and palate surgery
Surgery, usually in babies and children, to repair a gap in the lip and/or the roof of the mouth (palate) so that feeding, speech, hearing, teeth and appearance can develop as well as possible.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- Cleft care is a planned pathway over childhood, not one operation, and is led by a specialist multidisciplinary cleft team.
- Surgery aims to help feeding, speech, hearing, teeth and appearance develop well, but does not always avoid the need for further procedures or speech therapy.
- In the UK every child born with a cleft is automatically referred to one of the NHS cleft networks.
- Timing matters: the lip is usually repaired in early infancy and the palate later in the first year, with other procedures planned as the child grows.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your surgeon will give you advice for your situation.
Closes the gap in the lip and/or palate to support feeding
Care delivered by an isolated surgeon outside a specialist multidisciplinary cleft network.
Your child is helped with pain relief and feeding. The team checks the repair and shows you how to care for the mouth and any arm splints used to stop...
A named specialist cleft nurse and clear contact route for the family.
Your child is helped with pain relief and feeding. The team checks the repair and shows you how to care for the...
Expect swelling, some grizzliness and a need for soft feeds and regular pain relief. Keep fingers, dummies and...
Swelling settles and feeding returns towards normal. Lip stitches are removed or dissolve, and the scar begins as...
The lip scar gradually softens and fades. Speech, hearing and dental development are reviewed at planned intervals...
What is cleft lip and palate surgery?
A cleft is a gap in the upper lip, the roof of the mouth (palate), or both, that forms before birth. Cleft lip and palate surgery repairs these gaps so that a child can feed, speak, hear and develop their teeth and facial appearance as well as possible.
In the UK this is not a single operation but part of a long-term pathway run by specialist cleft teams. There are 12 NHS cleft networks, and every baby born with a cleft is automatically referred to one. A multidisciplinary team (MDT) — including cleft surgeons, specialist nurses, speech and language therapists, orthodontists, paediatric dentists, audiologists and psychologists — guides care from before birth or the early days of life through to adulthood.
The first operations usually repair the lip in early infancy and the palate later in the first year. Further procedures, such as a bone graft to the gum and sometimes jaw surgery in the teenage years, may be part of the journey. The aim is the best possible function and appearance over time, with the understanding that several stages may be needed.
Types & techniques
There isn't one single operation. The right approach depends on you — which is something to discuss with your surgeon.
Options at a glance
These are the main approaches described in this guide. The right option depends on the diagnosis, your goals and what your clinician thinks is safe.
Cleft lip repair (cheiloplasty)
Usually done in the first few months of life, this joins the tissues of the lip and reshapes them to restore a more typical appearance and lip function.
Cleft palate repair (palatoplasty)
Usually done later in the first year, this closes the gap in the roof of the mouth to help with feeding and, importantly, the development of clear speech.
Alveolar bone graft
Usually between about 8 and 12 years, bone (often from the hip) is placed into the gap in the gum line to support the adult teeth and the dental arch.
Speech surgery and revisions
Some children need further surgery to improve speech (for example if air escapes through the nose) or to refine the appearance of the lip or nose as they grow.
Preparing for your surgery
- Meet your cleft team's specialist nurse, who supports the family from before birth or the early days and explains the pathway.
- Get feeding support early, as babies with clefts often need special bottles or techniques before lip and palate repair.
- Make sure your child is well before each operation; surgery is usually postponed if they have a cold, chest infection or fever.
- Discuss the general anaesthetic with the team and follow the fasting instructions you are given.
- Ask what the operation involves, how long your child will stay in hospital, and what feeding will be like afterwards.
- Prepare for recovery at home, including soft feeds, pain relief and avoiding hard objects near the mouth.
- Keep up with hearing checks, dental care and speech reviews, which run alongside the surgery.
What happens
Each cleft operation is carried out under general anaesthetic by a specialist cleft surgeon, so your child is fully asleep. For a lip repair, the surgeon brings together and reshapes the tissues of the lip, and often the nose, with fine stitches. For a palate repair, the muscles and lining of the roof of the mouth are rejoined to close the gap and help the palate work for speech.
Operations usually take around one to three hours. Afterwards your child is cared for in recovery and then on the ward, where the team helps with pain relief and feeding. Most children stay in hospital for one or two nights.
Later procedures, such as a bone graft to the gum, follow the same pattern of a general anaesthetic and a short hospital stay, timed to your child's growth and dental development by the cleft team.
Is this operation right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- Care delivered by an isolated surgeon outside a specialist multidisciplinary cleft network.
- Operating on a child who is unwell with a cold, chest infection or fever, where surgery should wait.
- Surgery timed without regard to the child's growth and dental development.
- Promising a single operation will resolve everything, when a staged pathway is needed.
Delay surgery if…
- The child has an active infection, cold or fever.
- The child is too small or not yet well enough for safe general anaesthesia, as judged by the team.
- Feeding or weight gain needs to be established first.
- Dental or facial growth has not yet reached the right stage for a particular procedure such as a bone graft.
Alternatives to discuss
- Careful timing and staging of procedures rather than doing everything at once.
- Non-surgical support such as feeding aids, speech and language therapy and hearing management alongside surgery.
- Orthodontic treatment to prepare for or sometimes reduce the need for jaw surgery.
- A 'wait and see' approach to speech in some children before deciding on further surgery.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Anaesthetic choices
The safest option depends on the operation, your health, the facility and your surgeon/anaesthetist. Ask what is planned and why.
Benefits
- Closes the gap in the lip and/or palate to support feeding
- Helps the palate work for the development of clear speech
- Can improve the appearance of the lip and nose
- Supports healthy development of the teeth and dental arch, especially with a bone graft
- Works alongside hearing and speech care to support overall development
- Is delivered by an experienced multidisciplinary team within a structured pathway
Risks & complications
- Swelling, bruising and discomfort around the mouth or nose after surgery
- Temporary feeding changes while the repair heals
- Visible stitches and a scar on the lip that fades over time
- A short period of being unsettled and needing extra comfort
- Wound infection
- A small breakdown of part of the repair
- Bleeding needing review
- A need for further surgery as the child grows
- A hole (fistula) forming in the repaired palate, which may need another operation
- Speech that still needs further surgery because air escapes through the nose
- Complications related to the general anaesthetic
Cleft repair is well-established but is part of a longer journey, and some children need more than one operation for the palate, speech, teeth or jaw. The main uncertainties are how speech and facial growth will develop, which cannot be fully predicted in infancy. Care should always be through a specialist NHS cleft team rather than an isolated surgeon. Ask the team what this operation is expected to achieve, what the chances are of needing further surgery, and how speech and hearing will be monitored.
Published figures to discuss
Cleft surgery in the UK is delivered by experienced specialist teams within audited networks. The most important uncertainties are not single-operation risks but how speech, hearing, teeth and facial growth develop over years, and how often further procedures are needed. Exact rates vary between centres, cleft types and individual children, so the team's own outcome data and honest discussion matter more than headline figures.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Palatal fistula needing repair after palate surgery | Published rates vary widely; a recent review reported an average repair rate around 6.5% with a wide 0–49% range | Risk depends on cleft type, tissue quality, technique and healing; fistula can affect speech and feeding. | British Dental Journal — UK care pathway for children born with a cleftnature.comPublished figure |
| Velopharyngeal insufficiency (speech air leak) after palate repair | Reported roughly 5–30% across studies | May need speech therapy and sometimes secondary speech surgery. | British Dental Journal — UK care pathway for children born with a cleftnature.comPublished figure |
| Further operations during growth | Common across childhood and adolescence, but the type and number vary by cleft pattern | May include grommets, speech surgery, alveolar bone grafting, orthodontics or jaw surgery. | Guide sourcesClinical context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
Recovery — what to expect, and when
Recovery is described for each operation rather than as a single event. Most children recover from a lip or palate repair over one to two weeks at home, supported by the cleft team, though the wider pathway continues for years.
- Swelling and bruising of the lip, nose or palate that settles over weeks
- A red, firm lip scar that softens and pales over months
- Temporary changes to feeding and a need for soft feeds
- A child who is more unsettled and needs extra comfort for a few days
- Ongoing speech, hearing and dental reviews as part of the pathway
Aftercare
- Give pain relief as advised and offer soft or liquid feeds while the repair heals.
- Keep fingers, dummies, hard toys and utensils away from the repair as the team instructs, using arm splints if provided.
- Keep the lip wound clean and follow any instructions on creams or cleaning.
- Avoid hot foods and let your child rest and recover gently in the first week or two.
- Attend all follow-up, speech, hearing and dental appointments.
- Contact the cleft team promptly with any concerns about the wound, feeding or breathing.
- Lean on your specialist nurse and CLAPA for practical and emotional support.
- Soft or liquid feeds and any special bottles ready at home
- Pain relief as prescribed
- Arm splints (if provided) understood and to hand
- The cleft team's contact number saved
- Follow-up, speech and hearing appointments noted
- CLAPA support information for the family
Scars and how they heal
A cleft lip repair leaves a scar on the lip, which is red and firm at first and usually softens and fades over many months to become much less noticeable. Surgeons place the scar along natural lip lines. Palate repair is inside the mouth and not visible. Some children have further small operations over the years to refine the appearance of the lip or nose as they grow.
⚠ Get urgent help if…
- Difficulty breathing or noisy, laboured breathing — seek urgent help
- Bleeding from the mouth or nose that does not settle
- Increasing redness, swelling, heat or discharge from the wound (signs of infection)
- A high temperature or a child who seems very unwell or floppy
- Refusing feeds or far fewer wet nappies (signs of dehydration)
- A new gap or hole appearing in the repair
- Severe or worsening pain not helped by the prescribed pain relief
Who to contact: your surgeon or clinic first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your surgeon gives you.
Results & realistic expectations
A good result is a healed lip and/or palate that supports feeding now and, in time, the development of clear speech, healthy teeth and a balanced appearance. The lip scar usually fades well, and the palate repair gives the muscles the chance to work for speech.
Results unfold over years rather than weeks. Even with excellent surgery, some children need further procedures for the palate, speech, teeth or jaw, and some need speech therapy regardless of how well the repair healed. Facial growth and speech cannot be fully predicted in infancy, which is why long-term follow-up with the cleft team is built into the pathway.
A repaired cleft is a lasting repair, but the lip, palate, teeth and jaws keep growing throughout childhood, so the team reviews development over many years. Some young people need further surgery in the teenage years, such as a jaw operation once growth is complete. Adults treated for cleft as children can return to NHS cleft services later through their GP or dentist if new concerns arise.
Combining with other procedures
Cleft surgery is closely combined with feeding support, hearing care (including grommets if needed), speech and language therapy, orthodontics and dental care. The bone graft is timed around the eruption of the adult teeth, and any later jaw surgery is coordinated with orthodontic treatment. This joined-up, multidisciplinary care is central to good outcomes.
Follow-up & long-term care
Children are followed up regularly by the cleft team, with set reviews of speech (for example around 18 months, 3 years and 5 years), hearing, dental development and facial growth. Further surgery is planned around these reviews. The team coordinates care across all the specialists involved, and families are supported throughout, including by the specialist nurse and CLAPA.
- Regular cleft team reviews of speech, hearing, teeth and facial growth through childhood
- Ongoing dental and orthodontic care
- Speech and language therapy where needed
- Hearing monitoring, with grommets or hearing aids if required
- Planned later procedures (bone graft, speech surgery or jaw surgery) as growth dictates
Revision and secondary surgery reality
- Cleft care is staged: many children have several planned operations over childhood.
- Some children develop a hole (fistula) in the palate that needs a further repair.
- Some need additional surgery to improve speech if air escapes through the nose.
- A minority need jaw surgery in the teenage years once facial growth is complete.
Ask your surgeon for their own revision rate, what counts as a revision, and what is included in the written aftercare policy.
What good aftercare looks like
- A named specialist cleft nurse and clear contact route for the family.
- Structured follow-up of speech, hearing, teeth and facial growth at set ages.
- Coordinated input from surgery, speech therapy, audiology, orthodontics and psychology.
- Clear feeding and wound-care advice after each operation.
- Signposting to CLAPA and peer support for families.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- NHS cleft care is provided without charge through specialist networks, so cost is rarely a private question
- Where private input is sought, the surgeon's fee depends on the procedure and its complexity
- General anaesthetic and theatre or facility fees
- The number of stages and operations involved over time
- Associated care such as orthodontics, speech therapy and dental work
- Follow-up appointments across the multidisciplinary team
- Confirmation of which NHS cleft network is responsible for care
- For any private input, the surgeon's fee and what it covers
- The anaesthetic and facility fees
- Which later stages (bone graft, speech surgery, jaw surgery) may be needed and how they are provided
- How orthodontic, speech and dental care are coordinated and funded
- The follow-up arrangements across the team
On the NHS? Cleft care is provided on the NHS through specialist cleft networks, and every child born with a cleft in the UK is automatically referred; this is not a treatment families need to seek out privately.
You're entitled to your total cost in writing — including aftercare and any revision — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Not making clear that cleft care is a long-term, multi-stage pathway rather than one operation.
- Overstating how predictable speech and facial growth are in infancy.
- Care being offered outside an established multidisciplinary cleft network.
- Not explaining the chance of needing further surgery for the palate, speech, teeth or jaw.
- Underplaying the role of speech therapy, hearing care and orthodontics alongside surgery.
Marketing red flags
- Claims that a single operation will give a 'perfect' or 'scarless' result.
- Promising completely normal speech for every child.
- Offering cleft surgery outside a recognised specialist cleft team or network.
- Downplaying the need for long-term, multidisciplinary follow-up.
Choosing a surgeon safely
- Check your surgeon is on the GMC Specialist Register for this area.
- Make sure they practise at a CQC-registered location, and look for membership of bodies like BAAPS or BAPRAS.
- You're entitled to a two-stage consent process with time to reflect (a cooling-off period). The surgeon who will operate must consent you — not a salesperson.
- Be wary of pressure: time-limited offers, discounts or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including aftercare and any revision — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good surgeon will welcome every one of these.
- Which cleft network and team will care for my child?
- What is this particular operation expected to achieve?
- How likely is it that further surgery will be needed later?
- How and when will speech and hearing be monitored?
- What feeding support is available before and after surgery?
- How do we contact the team if we are worried after the operation?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the surgeon who carries out my operation, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this operation not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
When are cleft operations done?
Is cleft surgery done on the NHS?
Will my child need more than one operation?
Will my child speak normally?
Will the lip scar be very noticeable?
Where can we get support?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NHS — Cleft lip and palate CLAPA — About NHS cleft services CLAPA — Cleft treatment timeline British Dental Journal — UK care pathway for children born with a cleft Rate of secondary speech surgery after cleft palate repair — PubMed Rate of fistula repair following palatoplasty — JPRAS Cleft palate outcomes and palatal fistula — White Rose repository
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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