Cleft and Craniofacial Team

The UNM Cleft Team is a multidisciplinary team that is approved by the American Cleft-Palate Association. We care for patients from birth to 21 years of age. The team provides assessment, diagnosis, education, and treatment for children with the following diagnoses.

  • Cleft lip
  • Cleft palate
  • Submucous cleft palate
  • Velopharyngeal incompetence or insufficiency (VPI)
  • 22q11.2 syndrome
  • Microtia
  • Craniofacial macrosomia
  • Pierre Robin sequence
  • Stickler syndrome

Services Provided Include

  • Prenatal consultation for cleft
  • Newborn feeding support
  • Pediatric Otolaryngology (Ear, nose and throat)
  • Cleft Surgery
  • Audiology
  • Speech Pathology
  • Orthodontics
  • Oral Maxillofacial Surgery
  • Pediatrics
  • Psychology
  • Social Work
  • Child Life

ACPA accredited badgeACPA Approved Team

UNM Cleft and Craniofacial is an ACPA Approved Team and has met the Standards of Team Care for Cleft and Craniofacial Teams set by the American Cleft Palate-Craniofacial Association (ACPA). The ACPA Commission on the Approval of Teams has determined that UNM Cleft and Craniofacial is capable of providing cleft and craniofacial care in a coordinated and consistent manner, that care provided by UNM Cleft and Craniofacial follows the proper sequence and takes place within the framework of the patient’s overall developmental, medical and psychological needs. All approved teams in the U.S. and Canada are listed on the ACPA website.

Frequently Asked Questions

A cleft is a split or opening. A cleft occurs when parts of the skin, muscle, and bone of the mouth do not come together during weeks 5 to 12 of a pregnancy. A cleft lip is an opening in the lip, most commonly the upper lip. A cleft palate is an opening in the roof of the mouth. A baby can be born with a cleft lip, a cleft palate, or both. There is no pain or bleeding associated with the cleft palate.
It is not always clear why a child is born with a cleft. It can run in families, or it can be a completely new diagnosis to a family. Clefts occur very early in pregnancy and are often out of the control of the pregnant mother. Some clefts can be caused by specific genetic syndromes, and genetic testing is helpful for some patients. The team will discuss if this is recommended for your child.
Clefts are one of the most common birth defects in the United States. Cleft lip and/or palate occur in about one out of every 700 births. Cleft lip is most common in individuals with Native American and Asian ancestry and is least common in those of African ancestry. Cleft palate occurs equally in all racial groups.
Most children with a cleft lip and palate have surgery within their first year of life. The cleft lip is usually repaired between 4 and 6 months of age. The cleft palate is usually repaired between 10 and 14 months of age. This may vary depending on each patient’s needs.
The cleft team will frequently monitor speech and language development throughout childhood. Many children with cleft have normal speech. We can refer for further speech and language evaluations, if needed.
Children with cleft are more likely to have ear infections and issues with hearing. Hearing tests are done regularly for the first several years. When the muscles of the palate don’t work well, fluid can build up behind the ear drum. This fluid can make hearing lower. Many children need ear tubes placed in their first year of life. The tubes help drain the fluid and make the hearing return to normal. Some children with clefts need several sets of tubes throughout childhood. Often this gets better with age.
Children with clefts may have special dental needs. They should have routine dental care like any other child. There may be missing teeth, extra teeth, or incorrectly shaped teeth around the cleft. Dental hygiene is especially important for children born with cleft. They will likely need orthodontics when they are older.

Timeline of Care during the First Year

Babies born with cleft lip and palate should be seen by our team after they go home from the hospital, usually within a few weeks. They should see their primary care provider at least once per week for weight checks for the first few months of life. The main focus during this time is to support feeding. Our team’s speech pathologists are available to answer feeding questions or see babies for frequent visits if needed.

Newborn hearing screen:

  • We will check the results of your baby’s newborn hearing screen at their first appointment with the Cleft Team. If they did not pass, we will help set up a more sensitive hearing test to be done in the next few months.

Naso-alveolar molding:

  • Some babies with severe cleft lip can benefit from lip taping or naso-alveolar molding (NAM). This technique can be used to slowly mold the tissues of the nose and lip into a better position prior to surgery. This device is worn by the baby for several months and is adjusted weekly.

Surgical repair:

  • The goals of cleft lip surgery are to close the cleft lip with minimal scarring, to create a natural appearance, and to ensure typical growth of the face. The goals of cleft palate surgery are to close the cleft in the palate so that it can function normally during eating, drinking, and talking.

Lip repair:

  • The usual timing of the lip repair is between 4 and 6 months of age. Before surgery, the baby must be healthy and growing well. The surgery will be done under anesthesia, and takes several hours. The baby will stay overnight in the hospital afterwards.
  • The baby will have sutures and tape covering the lip afterwards. The sutures will be removed in the operating room one week later. This is a short procedure, and they will go home afterwards.
  • They can continue using their same bottle after surgery. You will be taught how to care for the lip before going home from the hospital.

Palate repair:

  • Repair of the palate is usually between 10 and 14 months of age. Before surgery, the baby must be healthy and growing well. The surgery will be done under anesthesia, and takes a few hours. The baby will stay overnight in the hospital afterwards.
  • They will hopefully be weaned from a bottle before surgery, but this may not be the case for every baby. They will be given a special cup to use called a “nosey” cup. This helps them drink without causing trauma to the palate. You will be taught what foods and drinks are safe before going home from the hospital.