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Health condition · Clinically reviewed

Cleft lip and palate, from antenatal diagnosis to adult care.

The most common congenital craniofacial anomaly in the UK. Cared for by a specialist multidisciplinary team from birth to adulthood, with a clear surgical journey and lifelong support.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against CRANE, RCPCH, NHS England and peer-reviewed cleft literature you can see at the end.

  • 03

    Current for 2026

    Reflects the UK supraregional cleft service model with MDT care from birth to adulthood.

Key facts

Cleft lip and palate at a glance.

The essentials, in plain English. What it is, the main types, and how UK cleft services care for children and adults with a cleft.

  • What it is

    The most common congenital craniofacial anomaly in the UK, affecting roughly 1 in 700 live births with variation by ethnicity and sex.

  • Main types

    Cleft lip only (about 20%), cleft lip and palate together (about 50%), and isolated cleft palate (about 30%).

  • Submucous cleft

    An intact mucosa with a muscular deficit underneath. Often missed at birth and picked up later through speech difficulty.

  • Syndromic overlap

    Roughly 15 to 30% of cases sit within a syndrome (Van der Woude, Stickler, Pierre Robin sequence, 22q11 deletion and others).

  • Care pathway

    Nationally commissioned through 12 UK cleft centres with a specialist multidisciplinary team from birth to adulthood.

  • Surgical journey

    A sequence of six or more procedures across childhood, starting with lip repair at 3 to 6 months and palate repair at 6 to 12 months.

Why this guide matters

One team, one journey, from birth to adulthood.

Cleft care in the UK sits within 12 supraregional centres and a specialist MDT. The three points below shape everything else on this page.

  • It is more common than families realise

    About 1 in 700 UK babies is born with a cleft. Cleft lip is often picked up antenatally, while isolated cleft palate is usually found at the newborn check.

  • The pathway is nationally commissioned

    Every UK family is referred to one of 12 supraregional cleft centres. Care is planned and delivered by one specialist team, not stitched together across services.

  • Outcomes are excellent with modern care

    Staged surgery, cleft speech therapy, hearing surveillance and orthodontics allow most children to grow up with clear speech, a well-supported airway and a confident smile.

How the diagnosis is made

From the 20-week scan to a specialist plan.

The steps a UK cleft service will normally follow, in order, so you know what to expect and why.

  1. 01

    Detecting

    Antenatal 20-week anomaly scan

    Cleft lip is picked up on ultrasound in 60 to 90% of cases. Isolated cleft palate is much harder to see antenatally.

  2. 02

    Detecting

    Antenatal counselling

    Parents are offered specialist cleft nurse counselling, CLAPA support and a plan for feeding and delivery.

  3. 03

    Detecting

    Newborn examination

    Every baby has a mouth and palate check within 72 hours. Cleft lip is visible at birth. Cleft palate is felt and seen with a torch and tongue depressor.

  4. 04

    Referring

    Referral to the regional cleft centre

    Within 24 hours of diagnosis, families are referred to one of the 12 UK supraregional cleft services for MDT assessment.

  5. 05

    Referring

    Feeding and growth review

    Specialist cleft nurse assessment with tailored bottles (Haberman, MAM, squeezable), positioning advice and weight monitoring.

  6. 06

    Planning

    Syndrome screen and genetics

    Examination for associated features (cardiac, renal, limb, ear), plus genetic counselling and targeted testing where indicated.

  7. 07

    Planning

    Surgical planning

    The MDT sets the timeline for lip repair at 3 to 6 months and palate repair at 6 to 12 months, with hearing and speech surveillance built in.

Typical timeline: from newborn diagnosis to cleft team assessment within 24 hours.

Signs and challenges

What families and clinicians look for.

A cleft is more than the visible gap. Feeding, hearing, speech, dental development and psychological wellbeing all sit alongside it.

  • Visible cleft lip

    Partial or complete, unilateral (more often on the left) or bilateral. Obvious at birth and often picked up antenatally.

  • Cleft palate

    A gap in the hard palate, soft palate or both. Seen and felt on newborn examination with a torch.

  • Feeding difficulty

    Inability to generate suction, slow feeds, nasal regurgitation, tiring at the breast or bottle and poor weight gain.

  • Submucous cleft signs

    A bifid uvula, a bluish midline on the soft palate and a notch on the hard palate. Often silent until speech develops.

  • Glue ear and hearing loss

    Eustachian tube dysfunction leads to persistent middle ear effusion, conductive hearing loss and delayed speech.

  • Cleft speech patterns

    Hypernasality, nasal air escape and characteristic articulation errors that respond to specialist cleft speech therapy.

  • Dental and orthodontic issues

    Missing, extra or malformed teeth, an alveolar cleft and malocclusion needing long-term orthodontic care.

  • Red flag - airway concern

    A small jaw with tongue-based obstruction (Pierre Robin sequence) is an airway emergency needing urgent tertiary review.

Treatment

The UK cleft surgical journey.

A staged sequence of procedures, coordinated by one MDT, alongside feeding, hearing, speech, orthodontics and psychology support throughout childhood.

  • Specialist feeding support

    Cleft nurse-led plans with Haberman, MAM or squeezable bottles. NG feeding and palatal plates are used selectively when growth stalls.

  • Cleft lip repair

    Performed at 3 to 6 months using Millard rotation-advancement, Fisher or Delaire techniques, often with primary rhinoplasty.

  • Cleft palate repair

    Performed at 6 to 12 months. Furlow double-opposing Z-plasty, intravelar veloplasty, Von Langenbeck, Bardach or Sommerlad techniques depending on anatomy.

  • Speech-improving surgery

    For velopharyngeal insufficiency at 3 to 5 years. Options include pharyngoplasty, secondary Furlow and selective fat grafting.

  • Alveolar bone graft

    Iliac crest bone graft at around 8 to 10 years, timed before eruption of the permanent canine into the cleft site.

  • Orthognathic surgery

    Le Fort I maxillary advancement in the teenage years for midface hypoplasia after growth is complete.

  • Secondary rhinoplasty and scar revision

    Refinement of the nose and lip scar in the teenage years, coordinated with orthodontics and orthognathic planning.

  • Hearing, speech and psychology

    Grommets for glue ear, ongoing cleft speech and language therapy, and psychology input for the child and family throughout childhood.

What this guide is based on

The sources behind every claim on this page.

UK national guidance, specialist society standards and the CRANE database, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your cleft team knows your child and your family history and can tell you which parts apply to you. If in doubt, contact your specialist cleft nurse.

  • NHS England. Cleft Lip and Palate Services Specification (nationally commissioned).

  • CRANE Database. Annual Report on Cleft Lip and Palate in the UK.

  • Royal College of Paediatrics and Child Health (RCPCH). Newborn and Infant Physical Examination (NIPE) standards.

  • Cleft Lip and Palate Association (CLAPA). Family and patient resources.

  • Royal College of Surgeons of England. Cleft Surgery Standards.

Red flags

When to escalate quickly.

Most cleft care runs to a predictable rhythm. These are the situations where the cleft team, ENT or paediatrics need to see the child sooner rather than later.

  • Airway obstruction in Pierre Robin sequence

    A small recessed jaw with tongue-based obstruction. Cyanosis, stridor or feeding-related desaturations need urgent tertiary airway assessment.

  • Failure to thrive

    Poor weight gain, prolonged feeds and dehydration warrant same-day cleft nurse review and paediatric input.

  • Missed submucous cleft

    Persistent hypernasal speech, nasal regurgitation or unexplained speech delay deserves ENT and cleft team review even with a normal-looking palate.

  • Persistent glue ear

    Recurrent middle ear effusion with conductive hearing loss can stall speech and language. Audiology surveillance and grommets are often needed.

  • Syndromic features

    A cleft with cardiac murmur, dysmorphic features, hypocalcaemia or limb anomalies needs genetics and paediatric cardiology review (consider 22q11).

  • Bleeding or airway concern after surgery

    Post-operative bleeding, breathing difficulty or fever after lip or palate repair needs urgent return to the operating team.

  • Psychosocial distress and bullying

    Low mood, school avoidance or appearance-related distress deserves cleft psychology and Changing Faces support.

  • Speech regression

    New hypernasality or nasal escape after previous good speech can signal velopharyngeal insufficiency or a fistula.

  • Dental infection at the alveolar cleft

    Pain, swelling or discharge at the alveolar cleft site needs prompt dental and cleft orthodontic review.

Living with it

A lifelong journey, with the team beside you.

Four things that make the biggest difference across the years. The MDT model, confident feeding, early speech and hearing support, and honest peer connection.

A quiet reminder

Cleft is a marathon, not a sprint.

The heart of good cleft care is a steady team relationship stretched across many years, from the newborn appointment to teenage rhinoplasty and beyond.

  1. 01 Team

    You are not alone with this

    From birth to adulthood, the UK cleft MDT walks alongside the family. Nurse, surgeon, SLT, audiologist, orthodontist and psychologist all sit at the same table.

  2. 02 Feeding

    Feeding is a skill, not a struggle

    Specialist bottles, upright positioning and shorter, more frequent feeds usually crack it within days. The cleft nurse is a phone call away.

  3. 03 Speech

    Words come with the right help

    Early cleft speech and language therapy, hearing surveillance and grommets when needed give the best chance of clear speech.

  4. 04 Support

    CLAPA and peer support matter

    The Cleft Lip and Palate Association, Changing Faces and Face Equality UK offer family, teenager and adult support that clinical teams cannot replace.

Frequently asked

Everything families ask about cleft.

Quick answers on causes, timing of surgery, UK cleft centres, speech, hearing and recurrence risk.

  • What is cleft lip and palate?

    Cleft lip and palate is a congenital gap in the upper lip, the roof of the mouth, or both, caused by incomplete fusion of the facial structures in early pregnancy. It is the most common congenital craniofacial anomaly in the UK, affecting roughly 1 in 700 live births.

  • What causes it?

    The cause is multifactorial. Genetic variants (IRF6, PAX9, MSX1, TGFB3 and others) interact with maternal factors including smoking, alcohol, folate deficiency, certain antiepileptics (phenytoin, valproate, topiramate), methotrexate, retinoids, diabetes and obesity. Around 15 to 30% of cases sit within a wider syndrome.

  • When are the repair operations done?

    Cleft lip repair is usually performed at 3 to 6 months of age. Cleft palate repair follows at 6 to 12 months. Further procedures such as speech surgery, alveolar bone grafting, orthognathic surgery and secondary rhinoplasty are staged across childhood and into the teenage years.

  • Where is cleft care delivered in the UK?

    Cleft care in the UK is nationally commissioned and delivered through 12 supraregional cleft centres, including Great Ormond Street, Chelsea and Westminster, Guy's, Birmingham Children's, Manchester, Alder Hey, Leeds, Newcastle, Bristol, Cardiff, Belfast, Edinburgh, Glasgow and Aberdeen. Each has a specialist multidisciplinary team.

  • Will my child need speech therapy?

    Most children with a cleft palate need input from a specialist cleft speech and language therapist. Regular surveillance starts early. Some children need further speech-improving surgery at 3 to 5 years if velopharyngeal insufficiency develops.

  • What is the recurrence risk in future pregnancies?

    For non-syndromic cleft, the risk in a sibling is roughly 2 to 4%, higher if more than one relative is affected. Syndromic cleft carries the recurrence risk of the underlying syndrome. Genetic counselling is offered to every family and preconception folic acid, smoking cessation and alcohol avoidance are recommended.

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