Cleft Palate Clinic
at The Children’s Hospital
Cleft Palate Clinic
at The Children’s Hospital
An Information Guide
for Parents and Families
An Information Guide
303-837-2574 for Parents and Families
About the Program
Welcome Outpatient Consultation Clinic/Team Evaluation
The Children’s Hospital Cleft Palate Clinic welcomes you, your child and Your child will receive a complete evaluation and consultation in one day.
family. We extend our expertise, compassion and support to facilitate the best • In the morning, your child receives speech-language and audiology
outcome possible for your child. evaluations and a social work consultation. Additionally, specially
The Cleft Palate Clinic has been providing services to children in the Rocky ordered x-rays and other tests are performed as needed.
Mountain region since 1970. It has grown to serve more than 200 children • The remaining members of the team examine your child in the afternoon.
annually. With its breadth of facilities, technology and consulting expertise, Then, a staff conference is held. Reports are compiled and sent to the
the Cleft Palate Clinic at The Children’s Hospital is the only major regional family and other involved healthcare personnel.
resource center bringing together the benefits of comprehensive care, teaching • Cleft palate clinics are held regularly throughout the year.
Multidisciplinary Team Approach
The Children’s Hospital Cleft Palate Clinic provides a multidisciplinary
team approach for children with cleft lip and/or palate, submucous cleft
palate, velopharyngeal incompetence, paralysis of the palate and oral-motor
coordination problems. The team approach allows us to manage all the
medical needs of the cleft palate child in a single location.
The members of the team include a coordinator, pediatric dentist, plastic
surgeon, pediatric otolaryngologist, speech-language pathologists, audiologists,
pediatricians, occupational therapist and a social worker. As appropriate,
consultations are available from other specialties at The Children’s Hospital.
The team is not a substitute or replacement for your local care providers
or primary care physician. The team’s goal is to provide coordination and
facilitation of care.
Cheyenne, Alejandro and Daniel enjoying a hike at Cleft Camp.
All children pictured in this brochure are cleft palate or cleft lip
The Diagnostic Team
Audiologist Pediatrician or Primary Care Physician
The audiologist evaluates your child’s hearing. Children with cleft lip and palate Children with clefts and/or craniofacial problems may have multiple medical
are at an increased risk for developing middle ear infections and hearing loss. problems that are unfamiliar to your primary care provider. Your PCP can help
These problems can result from the weak function of some of the palatal muscles. coordinate special testing or intervention that may be recommended.
These muscles are used to open the small tubes connecting the throat to the
middle ear. When the tubes do not open, air cannot enter the ear, causing fluid to Pediatric Dentist
form. For that reason, it is important to test your child’s hearing on a periodic Children with clefts of the lip and palate have the same dental problems as
basis. The audiologist tests your child’s behavioral responses to specific sounds non-cleft children, such as tooth decay or gum disease. In addition, they may
and speech, evaluates middle ear function and makes treatment recommendations. have special problems associated with the cleft, such as incorrectly shaped,
incorrectly positioned, missing or extra teeth. The pediatric dentist is trained to
Clinical Social Worker care for the dental needs of the very young or special needs child. These needs
The social worker obtains information about your family in order to provide may include fillings, teeth cleaning, space maintenance, removal of extra teeth
you with resource and educational information and materials, as well as and a plan for the child’s oral growth and development. Special dental appli-
counseling and support. As your child grows, his/her needs change as well. ances may be used to assist infants in feeding. At later ages, obturators (speech
The social worker is available on an ongoing basis to help with the many appliances) may be used to close palatal openings and provide better speech.
changes your child experiences as he/she goes through the stages of childhood
and adolescence. Pediatric Otolaryngologist
The pediatric otolaryngologist is concerned with feeding and breathing issues
Occupational Therapist and has special expertise in dealing with these difficulties. With the audiologist,
For a baby born with a cleft lip and/or palate, feeding is the most immediate the otolaryngologist is primarily responsible for evaluating hearing, ear infec-
issue that parents must face. Most of these babies can learn how to eat, but they tions and persistent fluid in the ears. The otolaryngologist may recommend
often need help because the split in the roof of the mouth makes it difficult for and place ventilation tubes in the eardrum to reduce infections, clear middle
them to suck. Because the nose and mouth are not fully separated by the palate, ear fluid and improve hearing. The otolaryngologist is also
food may back up and run out the nose. Choking, coughing, spitting or vomiting trained in the medical and surgical treatments for sinus
are some other issues that can affect feeding. The occupational therapist will infections, nasal airway obstruction, obstructive sleep
observe your child eating and help you develop a feeding plan that may include apnea, speech or resonance abnormalities, cleft lip
special techniques, positioning or feeding equipment. In addition, the occupa- and palate repair and cosmetic and reconstructive
tional therapist will assess your child’s overall development including move- procedures such as rhinoplasty or scar revision.
ment, play and hand skills.
Frequently Asked Questions
Pediatric Plastic Surgeon What causes cleft lip and palate?
The pediatric plastic surgeon has special expertise in the surgical repair of In most cases, there is no identifiable cause or risk factor. In the
patients with cleft lip and palate. The plastic surgeon is trained in all phases of United States, clefts occur in about one in every 700 births. Clefts
surgical treatment for the child with a cleft from the initial lip and palate repair can be hereditary and are more common in certain ethnic groups.
to scar revisions for the lip and nose, surgical treatment of speech and resonance
problems, alveolar reconstruction with bone grafting, orthognathic surgery, What treatment is available for
rhinoplasty, distraction osteogenesis and complex craniofacial reconstructive cleft lip and palate?
surgeries. He or she is responsible for developing the surgical plan of care over With proper treatment, your child’s cleft lip and/or palate can be repaired.
the childhood years and defining the timing for surgical procedures based on the Your child can look normal, eat without difficulty and speak clearly. However,
child’s growth and development in coordination with other physicians and health treatment is complex and many specialists need to work together to develop
professionals. Surgical intervention is phased to ensure the best functional and and carry out a plan that will meet your child’s individual needs.
Children with clefts benefit from specialized team care. These teams work
with the child’s primary care physician to provide the best care possible. Most
surgeons repair cleft lip when a baby is 2–3 months old and repair cleft palate
Children born with cleft lip and cleft palate may have problems in developing
at 9 to 18 months of age. The exact age for repair depends on the size and
speech and language skills. The speech-language pathologist on the team will
health of the child and the surgeon’s preference. Some children with clefts
evaluate your child’s ability to understand
require a second surgery on the palate to improve speech. Many children with
and use language and his/her speech
clefts require other operations, such as bone grafts, pharyngeal flaps and plastic
resonance (oral and nasal tone quality).
surgery, to improve the appearance of scars and to improve breathing.
Most children with cleft lip and/or palate
are slower in developing consonant sounds
Where can I get more information about clefts?
and in learning to talk. The speech-language
The cleft palate team at The Children’s Hospital is here to support you.
pathologist will provide information about
Additionally, many communities have support groups for parents with children
ways to encourage speech and language
with cleft lip and/or palate. Support groups provide practical help, share
development and recommend speech therapy
information about treatment and community resources and help other parents.
when needed. The team members work
The team at Children’s can refer you to parents and support groups. If you
closely with the speech-language pathologist
have questions or concerns, please call 303-837-2574.
to decide when surgery or dental appliances
may be necessary to improve speech and A public information service, CLEFTLINE, run by the Cleft Palate Foundation,
encourage normal resonance. provides free information about cleft lip and palate. The telephone number is
Daniel is ready to get on the ropes
course at camp. 800-242-5338.
Frequently Used Medical Terms
What will my child look like after surgery? Alar cartilage: The cartilage that forms the tip
Your child’s face will look better when the cleft lip and underlying muscles are of the nose and the nostrils.
joined. It may take as long as a year or two for the scar to fade. Sometimes Alveolar collapse: The condition in which one
what looks like a prominent scar may fade as the child grows. In general, more or both sides of the upper gum move to the cen-
than one operation is needed to give the best possible appearance. ter, behind the premaxilla, disrupting the normal
Alveolus (alveolar process, alveolar ridge): The part of the bony upper
jaw that contains teeth (the upper gum).
Arch (dental arch): The horseshoe shape of the upper gum.
Articulation: The process of forming speech sounds.
Audiologic evaluation: A hearing test.
Bilateral Cleft lip and
palate pre-op Cleft: A split or opening.
Columella: The center portion of the nose that divides the nostrils.
Deciduous teeth (baby teeth): The teeth that are expected to come out as
a part of normal development.
Lip and nose revision Eustachian tube: The tube that connects the middle ear to the back of the
Michael Lopez is an active eight-year- Fistula: An abnormal reopening occurring after surgical repair of the palate.
old involved with friends and school.
Michael’s family has nicknamed him Hypernasality (nasality): Greater than normal nasal resonance during
“Angel,” because “he is one.” He likes to speech.
ride his bike and play with his collection
of Matchbox cars. If you give him a
Mandible: The lower jaw (chin).
choice, chile fries are at the top of his Maxilla: The bony upper jaw.
menu. Michael’s cleft lip and palate were
repaired at The Children’s Hospital in a Mixed dentition: The time when children have some baby teeth and some
series of procedures beginning when permanent teeth.
Michael was 5 months old.
Lip and palate repair
Myringotomy: A procedure in which a tiny Prolabium: The front portion of the upper lip. The prolabium is the detached
incision is made in the eardrum to allow the part of the upper lip in the case of a bilateral cleft lip, often looking like a
release of pressure caused by excess fluid. bubble of flesh.
Multidisciplinary approach: A method of Submucous cleft: A cleft affecting the muscles that attach in the middle of
treating cleft lip and palate in which several the soft palate, but not affecting the skin covering.
medical, dental, speech, and hearing specialists
Unilateral cleft: A cleft that occurs on only the right side or left side of the
work together, coordinating their efforts and
planning a coordinated treatment.
Velopharyngeal closure: Made when the soft palate is raised to contact the
Nasal alae: The wings or sides of the nostrils. back wall of the throat. Closure is necessary for speech, blowing, and swallowing.
Nasal septum: The internal structure that divides the nasal cavity.
Obturator: A retainer-like device sometimes worn over the cleft of the hard
palate to aid in feeding and speech development.
Occlusion: The relationship between the upper and lower teeth when they are
Otitis media: An inflammation of the middle ear caused by infection, allergy,
or improper functioning of the eustachian tube.
Palate: The roof of the mouth, made up of the hard and soft palates.
Palatoplasty: The surgical closure of the cleft palate.
Pharyngeal: Relating to the pharynx or back of the throat.
Pharyngeal flap surgery: A procedure in which the surgeon creates a flap
of tissue that connects the soft palate to the back wall of the throat to improve
closure during speech.
The middle of the upper lip located above the vermillion and bordered on either
side by soft ridges or philtrum lines.Philatrum:
Katie reading her note from the tooth fairy.
Premaxilla: The front central section of the upper gum, containing the four
upper front teeth.
To dial a number from inside the hospital, you only need to use the last four
digits of the telephone number. To dial a number outside of the hospital, you
must dial “9” then the complete telephone number.
Due to interference with medical equipment and the fire system, cellular
phones cannot be used in patient care areas in the hospital. Please turn them off
while inside patient care areas.
The phones you see hospital personnel using are not cellular phones but modular
phones that work only inside the hospital and do not interfere with medical
Department Telephone Numbers
Blood Donor Center ..............................303-861-6373
Child Life Specialist ..............................303-864-5125
Clinical Social Work..............................303-861-6975
Creative Play Center..............................303-861-6999 Natalie Marie Smyth found her mom and dad when they came to visit an
Family Health Library ..........................303-861-6378 orphanage in Ukraine in 1999. She was adopted at 17 months of age. Her
Financial Counseling ............................303-861-6403 cleft lip and palate were repaired at The Children’s Hospital in Denver
Information Desk ..................................303-861-6218 shortly after she arrived in the U.S.
Interpreters ............................................303-837-2525 Natalie’s favorite place in the whole wide world is Elitch Gardens. She
Lactation Support Services....................303-861-6548 loves the rides and water park. Preschool has been great fun for her
Lost and Found ......................................303-861-6328 because she has made so many friends and learned so many songs.
Parking Services ....................................303-837-2761 Natalie loves her Kelly and Barbie dolls and chose a Barbie birthday
Patient Representatives ..........................303-861-6887 cake last birthday.
Public/Media Relations ........................303-861-6667
Her most exciting recent achievement is learning to swim underwater,
Ronald McDonald House ......................303-832-2667
in her words, “just like Ariel.”
TTD (hearing impaired) ........................303-861-6886
Volunteer Office ....................................303-861-6887