Cleft Lip & Palate
Children born with facial differences may undergo a variety of procedures and therapies as they grow, and managing those needs can feel overwhelming.
The goal of Dr. Williams and the team at Carolina Oral & Facial Surgery is to assist families in streamlining and coordinating visits to specialists and the hospital so that multiple specialists can provide you and your child with a unified plan of care here in Greenville, South Carolina, or in collaboration with leading craniofacial programs across the United States.
Cleft Lip & Palate
During early pregnancy, different parts of the face develop independently and then join together. When certain segments—such as those forming the upper lip or the roof of the mouth—do not fuse properly, a separation called a cleft occurs. A cleft may involve the lip, the palate, or both, and can vary significantly in severity.
- A cleft on one side is a unilateral cleft.
- A cleft on both sides is a bilateral cleft.
- A separation limited to the lip is a cleft lip.
- A separation in the roof of the mouth is a cleft palate.
- When both structures are involved, the condition is called a cleft lip and palate.
These conditions can affect appearance, feeding, hearing, speech, and dental development, and may influence confidence and social experiences as a child grows.
The Lip and Palate Matter as they Play Essential Roles in Early Development
Lip – A complete lip is important for normal facial appearance and suction during feeding.
Hard Palate – The hard palate forms the front portion of the roof of the mouth. It helps:
- Direct airflow through the mouth during speech
- Prevent food and liquids from entering the nose during eating
Soft Palate – The soft palate lifts and seals off the nasal cavity during speech and swallowing. If the soft palate muscles are not functioning properly, children may experience:
- Air leakage during speech
- Ear infections or hearing issues due to abnormal eustachian tube function
Cleft Lip Repair – Cleft lip repair is typically performed around 10 weeks of age. The goals of surgery are to:
- Close the separation
- Reestablish normal muscle function for feeding
- Create a more natural lip shape
Improvements in the nasal shape often occur, though additional nasal surgery may be needed as the child grows.
Cleft Palate Repair – Repair of the palate is usually completed between 7 and 18 months of age, depending on the child’s health and development. Early closure supports normal speech development.
Primary Goals of Palate Surgery
Surgeons may use different techniques depending on each child’s needs and goals. In many cases, the soft palate is repaired first due to its crucial role in speech. A small gap in the front of the hard palate (under the lip) may remain temporarily.
- Close the opening between the mouth and nose
- Reconnect and reposition the muscles that allow the palate to function
- Lengthen or reconstruct the palate so it can seal properly during speech
Generally, the alveolar hard palate repair is between the ages of 8 and 12 to provide continuity of the dental arch and to provide bone for teeth to erupt. Surgical timing is more a factor of what teeth are present and when they typically erupt. The procedure involves placement of bone from the hip or banked bone products into the bony defect with closure of the communication from the nose to the gum tissue in layers. The alveolar cleft can also be repaired in teenagers or adults if they missed the ideal timing for correction.
Alveolar Bone Grafting
The remaining bony gap in the gumline (alveolus) is typically repaired between 8 and 12 years old, timed to provide continuity of the dental arch and to provide bone for teeth to erupt. The procedure involves:
- Placing bone taken from the hip or using donor bone into the cleft
- Closing the tissue layers to separate the mouth and nose
- Restoring support for permanent teeth and the dental arch
Bone grafting can also be successfully completed in teenagers or adults who did not receive repair during childhood.
Healing and Possible Complications
After palate repair, children usually experience immediate improvement in feeding and swallowing. However, about 1 in 5 children may develop a small opening at the repair site, called a fistula.
- Small fistulas may cause only minor leakage of liquids
- Larger fistulas may contribute to eating or speech difficulties and often require additional surgery
Working with Children's Hospitals
At Prisma Health Children’s Hospital, the Greenville Cleft and Craniofacial Clinic provides children born with cleft lip and/or palate the benefit of coordinated comprehensive evaluation and care from multiple specialists, including experts in feeding, speech therapy, hearing, dentistry, orthodontics, psychology, and surgery.
Dr. Williams serves as the medical director, working with a multidisciplinary team dedicated to supporting children with craniofacial abnormalities each child’s health, development, and long-term well-being.
Alveolar Cleft Bone Graft – Frequently Asked Questions
What is an Alveolar Cleft Bone Graft?
An alveolar cleft bone graft (ACBG) is a procedure that repairs the gap in the bone and gum (alveolus) caused by a cleft. Permanent teeth develop within this bone, and children with clefts may not have enough bone support for proper tooth eruption.
During surgery, Dr. Williams typically uses BMP (bone morphogenic protein grafting) to correct the cleft of the alveolar ridge, This allows the cleft area to create a stable foundation for permanent teeth and future dental or orthodontic treatment. Hip grafting (iliac crest) is an additional grafting option.
How will my child look after surgery?
It is normal to see the following changes that are expected and temporary:
- Stitches on the gum behind the front teeth (they often look white)
- Mild bloody drainage from the nose or mouth
- Swelling of the lips
How do I care for the surgical sites?
Mouth/Gum Care
- Avoid brushing the graft area until Dr. Williams gives clearance
- Prevent trauma to the area
- Use a gentle salt-water rinse after meals
How will pain be managed at home?
Most children have minimal discomfort by the time they leave the hospital. All prescriptions by Dr. Williams will be electronically sent to the pharmacy provided at your presurgical appointment.
- Patients will receive detailed postoperative, including pain management instructions the day of their presurgical appointment and following surgery.
What can my child eat after surgery?
Immediately after surgery:
Very soft foods such as applesauce, yogurt, ice cream, and protein drinks.
The first 3 weeks after surgery:
No foods firmer than scrambled eggs.
Important restrictions:
- No straws
- No biting into foods with the front teeth
- Make sure your child drinks plenty of fluids
- Rinse with a mild salt-water solution after meals
When will my child have a follow-up appointment?
Our office will schedule your child’s one-week postoperative visit at their presurgical appointment. If you need to reschedule, contact us as soon as possible.
When should I call Dr. Williams or the office with concerns?
Call the office (864) 458-9800 if your child experiences:
- Bright redness at the gum or incision site
- Pus-like drainage
- Increased swelling
- Oral temperature over 101°F
Parent Resources
Our goal is to create a safe, welcoming environment where your child feels comfortable and cared for from the moment they arrive. These resources are designed to help parents understand what to expect before and during surgery, and how to best prepare children of all ages for a positive experience.
Why choose Carolina Oral & Facial Surgery?
Our team is committed to supporting you and your family every step of the way with the highest standard in oral surgery and exceptional healthcare.
We Are Here to Help You Prepare
At Carolina Oral & Facial Surgery, we are committed to providing the highest level of care and treatment for every patient. See helpful information to guide you before and after your surgery.