The Care Journey

Cleft lip is often detected on prenatal ultrasound between 18–22 weeks. Cleft palate alone and craniosynostosis are more often diagnosed after birth.

If diagnosed prenatally, we encourage families to schedule a consultation before the baby arrives. This allows time to discuss the treatment plan, connect with support resources, and prepare emotionally.

If diagnosed at birth, the pediatrician will refer you to Dr. Chaiyasate's craniofacial team. The first consultation is typically scheduled within the first few weeks of life.

At this stage, the most important thing is feeding. Our team includes feeding specialists who will help you find the right bottles and techniques to ensure your baby is well-nourished and gaining weight.

During the first consultation, Dr. Chaiyasate will perform a thorough examination, review any imaging, and discuss the diagnosis with you in detail.

You will meet members of the multidisciplinary team — including speech therapy, audiology, orthodontics, and genetics — who will be involved in your child's care over the coming years.

Dr. Chaiyasate will outline the complete treatment plan, including the timing and sequence of surgeries, expected outcomes, and what to watch for at each stage.

This is your opportunity to ask all of your questions. No question is too small. We want you to feel informed, supported, and confident in the plan.

For cleft lip, nasoalveolar molding (NAM) may be started at this time — a custom-made device that gently shapes the lip and nose before surgery to improve surgical outcomes.

Cleft lip repair is typically the first surgery, performed around 3–6 months of age following the 'Rule of 10s' — baby is at least 10 weeks old, weighs at least 10 pounds, and has a hemoglobin of at least 10 g/dL.

Dr. Chaiyasate uses advanced techniques (Millard rotation-advancement, Fisher subunit repair) to create a natural-looking lip with minimal scarring. The nose is also addressed at this time.

The surgery takes approximately 1.5–2.5 hours under general anesthesia. Most babies stay one night in the hospital.

Recovery: Arm restraints for 2–3 weeks to prevent the baby from touching the repair. Syringe or squeeze bottle feeding for 2–3 weeks. Sutures dissolve on their own or are removed at the first follow-up visit.

For craniosynostosis: Endoscopic surgery is performed at 2–4 months, followed by helmet therapy. Open cranial vault remodeling is performed at 6–12 months.

Cleft palate repair is performed between 9–18 months, ideally before the child begins developing speech (around 12 months).

The goal is to create a functional palate that separates the mouth from the nose, allows normal feeding, and — most importantly — enables normal speech development.

Dr. Chaiyasate uses techniques such as the Furlow double-opposing Z-plasty or two-flap palatoplasty, chosen based on the specific anatomy of the cleft.

Hospital stay is typically 1–2 nights. Recovery involves 2–3 weeks of soft diet (no bottles, straws, or pacifiers), arm restraints, and pain management.

After palate repair, speech development is closely monitored. Most children develop normal speech, but about 20–30% may need additional speech surgery later.

After palate repair, your child's speech development is monitored by a speech-language pathologist (SLP) who specializes in cleft palate speech.

Regular speech evaluations begin around 18 months and continue through the preschool years. Early intervention is key — the earlier speech issues are identified, the better the outcomes.

Most children benefit from speech therapy to develop correct articulation patterns. The SLP works with the family to incorporate speech exercises into daily routines.

If velopharyngeal insufficiency (VPI) is identified — where the palate doesn't close completely during speech, causing nasal-sounding speech — secondary speech surgery (pharyngoplasty or pharyngeal flap) may be recommended, typically around age 4–6.

Ear tubes (myringotomy tubes) are often placed during one of the early surgeries, as children with cleft palate are prone to middle ear fluid and infections. Hearing is monitored by an audiologist.

If the cleft extends through the gum line (alveolar cleft), bone grafting is performed to fill the gap in the dental ridge. This provides bone support for the permanent teeth to erupt and stabilizes the dental arch.

The bone graft is typically harvested from the hip (iliac crest) — a small amount of cancellous (spongy) bone is taken through a small incision. Some surgeons use bone from the chin or tibia.

Timing is coordinated with the orthodontist — the graft is placed just before the permanent canine tooth erupts into the cleft area (usually age 8–12, based on dental X-rays).

Orthodontic treatment (braces) is typically started before the bone graft to align the dental arches, and continues after the graft to guide teeth into proper position.

Hospital stay is typically one night. The hip donor site is sore for 1–2 weeks but heals well with minimal scarring.

As the face reaches adult proportions, refinement procedures may be considered to optimize both function and appearance.

Rhinoplasty (nose surgery): The cleft nose often has asymmetry that becomes more noticeable with growth. A definitive rhinoplasty is performed after nasal growth is complete (typically age 16–18). This addresses both the cosmetic appearance and nasal airway function.

Orthognathic surgery (jaw surgery): About 25–30% of patients with cleft lip and palate develop midface deficiency (underdeveloped upper jaw) that cannot be corrected with orthodontics alone. Le Fort I osteotomy advances the upper jaw to correct the bite and improve facial balance.

Lip revision: If the lip scar is wide or the lip shape is not optimal, a lip revision can improve the result. This is a relatively minor outpatient procedure.

These procedures are elective and are discussed with the patient and family. The goal is for the patient to feel confident and comfortable with their appearance as they enter adulthood.

Craniofacial care doesn't end at age 18. Dr. Chaiyasate continues to follow patients into adulthood, addressing any ongoing needs and providing support during the transition to adult healthcare.

Long-term follow-up may include monitoring dental health, nasal airway function, speech quality, hearing, and psychosocial well-being.

Some patients choose to have additional refinement procedures as adults — such as scar revision, rhinoplasty touch-up, or fat grafting for contour improvement.

The goal of the entire care journey is for the patient to reach adulthood with normal function (speech, hearing, breathing, eating), a natural appearance, and the confidence to live a full and fulfilling life.

We are proud to have patients who have grown up to be doctors, engineers, teachers, athletes, and parents themselves — living proof that a cleft or craniofacial condition does not define a person's potential.