Cleft Lip and Palate Operation: Causes, Treatment and Care in India

A cleft lip or cleft palate is a gap in the upper lip, the roof of the mouth, or both, present from birth. If your baby has been diagnosed, or a scan has raised the possibility, you are probably asking three things: what happens next, when the operation is done, and how to find good care without losing months to confusion or cost.

This guide explains what clefts are, how they are classified, what is known about causes, how a cleft lip and palate operation works and when it is usually done, how to feed your baby, where families in India can start looking for treatment and financial support, and what follow-up care looks like. Timings below are typical ranges. Your child’s cleft team decides the actual plan.

In India, an estimated 35,000 or more babies are born with a cleft lip and/or palate each year. You are not alone, and the condition is treatable.

Quick answers

• Cleft lip repair is usually done at around 3 to 6 months, and cleft palate repair at around 6 to 12 months. Protocols differ between teams and between children.

• Clefts are thought to arise from a mix of genes and other factors. Parents are not to blame.

• Clefts can affect feeding, hearing, speech and teeth, so care involves a team and continues into the teenage years.

• Free or subsidised surgery is available through NGO-supported programmes at partner hospitals. Confirm eligibility directly with the hospital or organisation.

What Are Cleft Lip and Cleft Palate?

A cleft lip happens when the tissue that forms the upper lip does not join completely before birth. The gap can be on one side, on both sides, or in the middle of the lip, and it can extend into the gum and nose. A cleft palate happens when the tissue forming the roof of the mouth does not join fully. The two can occur together or separately.

	Cleft lip	Cleft palate
What it is	A gap in the upper lip, sometimes reaching the gum and nose	An opening in the roof of the mouth
Visible at birth	Usually obvious	May be hidden inside the mouth; some types, such as submucous cleft or bifid uvula, are found later
Main early concerns	Appearance, lip and nose shape, feeding adjustments	Feeding, ear fluid and hearing, later speech
Occurs with the other?	Often. In one clinical source, about 68% of unilateral and 86% of bilateral cleft lips came with a cleft palate	Can occur alone or with a cleft lip

Types and Classification of Cleft Lip and Palate

Clinicians describe a cleft by four things: which side (unilateral or bilateral), how far it extends (complete or incomplete), which structures are involved (lip, alveolus or gum, hard palate, soft palate), and whether it is isolated or part of a syndrome. Clefts are more often on the left side.

Cleft gum (alveolar cleft). A cleft lip and alveolus extends across both the lip and the gum. This is what some parents mean by a “cleft gum in a newborn”. It usually needs a bone graft later in childhood, planned with the orthodontist.

Bilateral clefts. Both sides of the lip are affected, and the palate is usually involved too. Repair is typically more complex than for a unilateral cleft, so ask your surgeon about the planned approach and the number of stages.

The Veau classification, widely used for palate clefts, groups them like this:

Veau group	What it describes
I	Cleft of the soft palate only
II	Cleft of the hard and soft palate
III	Complete unilateral cleft of the lip, gum and palate on one side
IV	Complete bilateral cleft of the lip, gum and palate on both sides

Other systems, such as Kernahan’s “striped Y” and the Iowa classification, give surgeons a shorthand for recording exactly where a cleft lies. Your child’s notes may use them.

What Causes Cleft Lip and Cleft Palate?

There is rarely one cause. Clefts are thought to result from a combination of genes and other factors, acting while the lip and palate form in early pregnancy. In most families there is no clear reason, and nothing a parent did or did not do can be identified as the cause. Please do not blame yourself.

Risk factors that research has identified

• Smoking and exposure to tobacco smoke during pregnancy.

• Certain medicines taken in early pregnancy, including some anti-epilepsy drugs such as topiramate. Never start or stop a medicine without your doctor’s advice.

• Pre-existing diabetes

• Family history and genetic conditions.

Is it more common in boys or girls? 

In clinical series, cleft lip (with or without palate) is more common in boys, and isolated cleft palate is more common in girls.

Genetic syndromes and genes. 

Most clefts occur on their own. Some are part of a syndrome. Van der Woude syndrome is the most frequent syndromic form of cleft lip and palate and is linked to changes in the IRF6 gene. 22q11.2 deletion syndrome and Robin sequence (a small lower jaw with airway and feeding problems and a cleft palate) are others, and Stickler syndrome is also associated with cleft palate. If your child has other differences, such as heart problems, hearing loss or unusual facial features, ask for a genetics review.

Can Cleft Lip and Palate Be Prevented?

There is no guaranteed way to prevent a cleft. What you can do is lower known risks and follow your doctor’s advice: avoid smoking and tobacco smoke, review every medicine with your doctor before and during pregnancy, and manage diabetes with your care team.

Folic acid. Folic acid clearly reduces the risk of neural tube defects, which is why doctors recommend it before and during early pregnancy. For clefts the evidence is mixed. A Cochrane review of trials found no clear effect on cleft lip or cleft palate, though the evidence was low quality.

A later meta-analysis of observational studies found lower risk of cleft lip with or without cleft palate among women who used folic acid-containing supplements, with a lot of variation between studies.

A review in the Indian Journal of Plastic Surgery concluded that high-dose folic acid may help prevent recurrence of cleft lip with or without palate in high-risk families, but not isolated cleft palate, and noted limited evidence. Take folic acid as your doctor advises, and do not treat it as a guarantee against a cleft.

Can Cleft Lip and Palate Be Detected on Ultrasound?

Often, yes, especially for cleft lip. The CDC notes that clefts, particularly cleft lip, can be diagnosed during pregnancy by a routine ultrasound. Isolated cleft palate is harder to see and can be missed, and some types, such as a submucous cleft or bifid uvula, may not be found until later in life.

In the UK pathway, a cleft lip is usually picked up at the mid-pregnancy anomaly scan, while a cleft palate is often confirmed within the first day after birth.

If a scan suggests a cleft, ask your obstetrician for a referral to a fetal medicine specialist or cleft team for counselling.

A scan cannot predict everything, including how extensive the cleft is or whether other conditions are present, so further assessment after birth matters. It also gives you time to learn about feeding before the baby arrives.

Cleft Lip and Palate Operation: Procedure, Timing and Recovery

How treatment planning works

A cleft team assesses your baby and builds a plan. The team usually includes a surgeon, a nurse or coordinator, a paediatrician, an anaesthetist, an audiologist, a speech-language therapist, a dentist or orthodontist and a psychologist. The aims of surgery are to close the gap, support feeding, hearing and speech, and improve the appearance of the lip and nose.

No two plans are identical, and protocols differ between centres. An ICMR-led pilot study at three Delhi-NCR cleft centres (AIIMS, Safdarjung Hospital and Medanta) found wide variation in the age at first surgery and in the quality of treatment, and a significant share of children needed later lip and nose revisions. That is why the experience of the team matters as much as the operation itself.

Typical treatment timeline

Age	What usually happens
Before birth to newborn	Cleft lip may be seen on a scan. Feeding assessment, newborn hearing screen and referral to a cleft team
3 to 6 months	Lip repair. Some teams also close part of the palate at this stage
6 to 12 months (some teams later)	Palate repair. UK services use 6 to 12 months; one US children’s hospital quotes about 10 to 12 months; two-stage protocols repair the hard palate at 15 to 18 months
7 to 10 months onwards	Hearing tests and regular monitoring for children with a cleft palate
About 18 months, 3 years and 5 years	Speech and language assessments
8 to 12 years	Bone graft to the gum area, if needed, with orthodontic preparation
12 to 15 years	Orthodontic treatment, jaw growth monitoring and any further surgery

These are typical windows, not deadlines. A large trial compared palate repair at 6 and 12 months. UK cleft teams who reviewed it concluded that both ages gave good speech at five years, with a small difference in nasal-sounding speech favouring the earlier repair. Your surgeon will weigh your child’s health, weight, type of cleft and local protocol.

Common procedures

• Cleft lip repair (cheiloplasty) closes the lip and reshapes the lip and nose. The Millard rotation-advancement technique is widely used for unilateral clefts.

• Cleft palate repair (palatoplasty) closes the opening in the roof of the mouth and repositions the muscles of the soft palate so it can seal off the nose during speech. Techniques include intravelar veloplasty (the Oxford palatoplasty) and two-stage approaches.

• Alveolar bone graft fills the gap in the gum, usually in mid-childhood, so that teeth can erupt through it.

• Revision surgery may refine the lip or nose, or address speech if the palate does not close off the nose well enough (velopharyngeal surgery).

How many surgeries will my child need?

It varies. A cleft lip repair often needs one operation, and a cleft palate repair may need one or two. Beyond these, some children need lip or nose revision, speech surgery, a bone graft, or jaw surgery in the teenage years. Some children need only the primary repairs; others have several procedures across childhood. Ask your team for a written outline of the expected stages.

Recovery and aftercare

Your hospital will give specific instructions. Common themes include protecting the repair (for example, many teams advise avoiding straws after lip surgery), pain relief, and feeding adjustments. After palate surgery, teams often use a special feeder, a syringe, an open cup or a special sippy cup for a period; many babies then return to their usual way of feeding. Keep every follow-up appointment.

Risks

Cleft repair is routine in specialist centres, but no operation is risk-free. The most common anaesthetic complications are airway and breathing problems. Surgical risks include the wound opening partly or fully, scarring and the need for further procedures. Outcomes depend on the type of cleft, your child’s overall health and the team’s experience.

What does a cleft operation cost in India?

We have not published a figure because we could not verify current costs. In practice, private hospitals quote a package that varies by hospital, city, surgeon and the stage of treatment. NGO-supported partner hospitals provide surgery free of charge for eligible children. Ask for an itemised estimate that covers the surgeon, anaesthesia, hospital stay, tests, medicines and follow-up, and ask separately about speech therapy, hearing care and orthodontics, which continue for years.

Best Hospitals in India for Cleft Lip and Palate Treatment: How to Choose and Where to Start

We do not rank hospitals, and no official ranking was found. The table lists centres where a cleft service is documented in sources we could check, and what we could and could not confirm.

What to look for

• A dedicated cleft or craniofacial team that includes speech therapy, audiology, orthodontics and psychology, not only a surgeon.

• A surgeon who performs cleft repairs regularly, and paediatric-trained anaesthesia.

• Follow-up that continues into the teenage years.

• Clear, itemised costs, or a documented NGO programme.

Questions to ask any hospital

1. How many cleft repairs does the surgeon perform each year?

2. Who is on the cleft team, and do speech therapy and audiology happen at the same centre?

3. Who will give the anaesthetic, and do they treat infants regularly?

4. What follow-up is planned until adulthood, and is it included in the cost?

How to confirm eligibility and cost

1. Ask the hospital’s plastic surgery or cleft clinic whether it is an NGO partner.

2. Ask what is covered: surgery, tests, stay, medicines, travel and follow-up.

3. Ask about age limits. For example, one AIIMS scheme lists 6 months to 12 years.

4. Keep your registration and medical documents together.

5. Be cautious of anyone who asks you to pay for a programme described as free.

Feeding a Baby With Cleft Lip and Palate

Feeding is usually the first worry. Most babies with a cleft palate can feed well with the right equipment and technique, and your cleft nurse or feeding specialist can show you in person.

Situation	What usually helps
Cleft lip only	Breastfeeding or a regular bottle is often possible; a teat with a wider base can help
Cleft palate, with or without cleft lip	The baby cannot create enough suction, so a special squeezable or assisted-flow bottle is usually needed. If you plan to breastfeed, expressing milk and giving it by special bottle is a common approach
Breastfeeding	Many babies with a palate cleft need top-up bottle feeds. Success depends on the type of cleft and milk supply; ask for lactation support
Position and pace	Hold the baby upright, point the teat away from the cleft, go at the baby’s pace and burp often, because babies with clefts swallow more air. After a feed, lay the baby on their back to sleep
Bottles (examples)	The Mead Johnson cleft lip/palate nurser, the Medela SpecialNeeds Feeder (formerly the Haberman feeder) and the Pigeon cleft palate nurser. Availability in India is not verified; ask your cleft team. Check cleaning instructions, because some cannot be boiled or microwaved
Squeezing technique	Gently pulse the bottle in rhythm with the baby’s sucking rather than squeezing continuously
Is my baby getting enough?	Frequent wet and dirty nappies, a settled baby after feeds and steady weight gain. Your paediatrician will track weight
Solids	Usually at the same age as other babies, around 4 to 6 months
After surgery	Follow your surgeon’s plan. Teams may use a special feeder, syringe, open cup or special sippy cup, and many babies return to their usual feeding

Talk to your cleft team or paediatrician if feeds take very long or leave the baby exhausted, if weight gain is slow, or if the baby coughs or chokes often.

Cleft Lip and Palate Care Plan

Cleft care is a long-term plan, not a single operation. A typical plan runs like this.

Stage	Focus
Newborn	Feeding support, newborn hearing screen, referral to a cleft team, early dental advice
3 to 6 months	Lip repair
6 to 12 months	Palate repair; hearing test at 7 to 10 months
18 months to 5 years	Speech assessments, yearly hearing checks, dental prevention; lip or speech surgery if needed
6 to 12 years	Speech and hearing follow-up, full team review around age 10, orthodontic planning, bone graft if needed
12 to 15 years and beyond	Orthodontics, jaw growth monitoring, further surgery if needed, psychological support as needed

Hearing. Children with a cleft palate are more likely to get fluid in the middle ear (glue ear), which can reduce hearing. It can be treated with grommets or hearing aids.

Speech. Palate repair greatly reduces the chance of speech problems, but some children still need speech therapy. In UK services, around half of children with a cleft palate need some speech and language therapy. A repaired palate can still leave nasal-sounding speech or unclear consonants.

Therapy tools such as listening tubes, mirrors and guided exercises are described in our guide on. Therapy alone is sometimes not enough, so assessment decides whether further treatment, including speech surgery, is needed.

Care checklist

• A named cleft coordinator or team contact.

• Feeding and weight reviewed at every early visit.

• Hearing tests on schedule, and a plan if fluid is found.

• Speech assessments at about 18 months, 3 years and 5 years.

• A dentist who works with the cleft team, from the first months of life.

• Orthodontic review in mid-childhood, before any bone graft.

• Psychological and family support when you need it.

Role of Anaesthesia in Cleft Lip and Palate Surgery

Cleft repair in infants is done under general anaesthesia, delivered by a paediatric anaesthesia team. Reviews of cleft anaesthesia describe a careful assessment before surgery that looks at general fitness, growth and feeding, any snoring or breathing pauses during sleep, and associated conditions.

Babies with Robin sequence or other syndromes have a higher risk of airway problems after palate repair. If a child has a cold or chest infection at the time, surgery is often postponed, because breathing complications are more common then.

After the operation the team watches closely for airway blockage during recovery. Studies of cleft anaesthesia report that airway and breathing problems are the most frequent complications, and that they are more likely in younger infants and in children with respiratory symptoms before surgery.

What you can do: tell the team about snoring, breathing pauses, recent colds and any earlier anaesthetic, follow the fasting instructions you are given, and ask who will give the anaesthetic and whether they treat infants regularly.

Role of AAPD in Cleft Lip and Palate Dental Care

The American Academy of Pediatric Dentistry (AAPD) is a US professional body. Its Policy on the Management of Patients with Cleft Lip/Palate and Other Craniofacial Anomalies sits in its Reference Manual of Pediatric Dentistry.

The policy endorses the parameters of care from the American Cleft Palate-Craniofacial Association and says care for these children should be comprehensive, coordinated, culturally sensitive and specific to each child.

It describes dental care that includes oral health examinations, preventive measures, restorative care and management of space for teeth, with the dentist working alongside orthodontic and oral and maxillofacial surgery colleagues.

In practice this means starting dental care early, choosing a paediatric dentist who is happy to coordinate with your cleft team, and expecting orthodontic planning in childhood and around bone grafting. Because the AAPD is American, add a relevant Indian paediatric dentistry source before publishing.

Frequently Asked Questions

What is a cleft palate? 

A cleft palate is an opening in the roof of the mouth that happens when the tissue forming the palate does not join completely before birth. It can occur with or without a cleft lip and can affect feeding, hearing and speech.

What causes cleft lip and palate? 

Clefts are thought to result from a combination of genes and other factors during early pregnancy. In most cases no single cause is found, and parents are not to blame. Smoking and some medicines taken in pregnancy are among the risk factors studied.

Who is most at risk? 

Children whose mothers smoked or were exposed to tobacco smoke in pregnancy, or took certain medicines such as some anti-epilepsy drugs, have a higher chance, and so do children with a family history or a genetic syndrome. Most babies with a cleft are born to families with none of these.

Is cleft palate more common in boys or girls? 

In clinical series, cleft lip with or without palate is more common in boys, and isolated cleft palate is more common in girls.

Can a lack of folic acid cause a cleft palate? 

Not established. Folic acid clearly prevents neural tube defects, but for clefts the evidence is mixed: trials found no clear effect, while some observational studies found lower risk of cleft lip with or without palate with folic acid supplements. Follow your doctor’s advice and do not rely on it as a guarantee.

How can I reduce the chance of a cleft in pregnancy? 

There is no guaranteed prevention. Avoid smoking and tobacco smoke, review all medicines with your doctor, manage diabetes with your care team and take folic acid as advised.

Can cleft lip and palate be detected during pregnancy? 

Often for cleft lip, by routine ultrasound. An isolated cleft palate is harder to see and may be found only after birth. If a scan suggests a cleft, ask for referral to a cleft team for counselling.

What is a cleft gum in a newborn? 

It is a cleft of the alveolus, the tooth-bearing ridge of the upper jaw. It often comes with a cleft lip and usually needs a bone graft in mid-childhood, planned with an orthodontist.

How can a baby with a cleft palate be fed safely? 

Most babies with a cleft palate cannot create enough suction for a standard bottle or breast. A special squeezable or assisted-flow bottle, upright positioning, a slow pace and frequent burping usually help. Your cleft nurse or feeding specialist can show you in person.

What is the procedure for cleft palate surgery? 

The surgeon closes the opening in the roof of the mouth and repositions the palate muscles so the palate can seal off the nose during speech. Some teams do this in one operation and others in two stages.

At what age is cleft lip surgery usually done? 

Usually at around 3 to 6 months. Your surgeon will adjust the timing to your baby’s health and weight.

What age is best for cleft palate repair? 

Commonly around 6 to 12 months, and some two-stage protocols repair the hard palate at 15 to 18 months. A large trial comparing 6 and 12 months found good speech at five years with either, so the “best” age depends on your child and your team.

How many surgeries are needed to fix a cleft palate? 

Often one or two for the palate itself. Some children later need lip or nose revision, speech surgery, a bone graft or jaw surgery, while others need only the primary repairs.

Is cleft lip and palate surgery safe? How risky is it? 

It is routine in specialist centres, but no operation is risk-free. The main risks are airway and breathing problems around anaesthesia, the wound opening, scarring and the need for further procedures. An experienced team and a good pre-operative assessment lower these risks.

How is a bilateral cleft lip treated? 

Both sides of the lip are repaired, and the palate is usually repaired too. Bilateral repair is typically more complex than unilateral, and techniques vary by surgeon, so ask about the planned approach and number of stages.

What is Smile Train?

Smile Train is a cleft-focused charity that funds free cleft surgery and related care through partner hospitals in India and other countries. Check its official site or your hospital for current partners and eligibility.

How can families find financial assistance in India? 

Start by asking the hospital’s plastic surgery or cleft clinic whether it is an NGO partner, then confirm what is covered and any age limits. Some state health programmes also work with NGOs; the Himachal Pradesh agreement with Smile Train identifies children through national child health screening.

Which hospitals provide multidisciplinary cleft care in India? 

See the table in the hospitals section. It lists centres with documented cleft services and what could and could not be verified. No official ranking exists, so ask each hospital about its team, surgeon experience and follow-up.

What is the most common genetic syndrome associated with cleft palate?

Van der Woude syndrome is the most frequent syndromic form of cleft lip and palate, caused by changes in the IRF6 gene. 22q11.2 deletion syndrome is another well-known one, and Robin sequence and Stickler syndrome are also associated with cleft palate.

What genes are associated with cleft palate? 

IRF6 is linked to Van der Woude syndrome, and 22q11.2 deletions are linked to a syndrome that often includes palate differences. Most clefts without a syndrome involve several genes together with environmental factors, not a single gene. Genetic counselling can assess your family’s chance.

What other birth defects are associated with a cleft palate? 

Most children have a cleft alone. When a syndrome is present, other features can include heart defects, hearing loss, a small lower jaw with breathing and feeding difficulty, or eye and joint problems. Ask for a genetics review if your child has other differences.

HOLD: Is being born with a cleft palate a disability? 

Do not publish until a legal source (for example, the current Indian disability legislation and its schedule of conditions) and a clinical source are checked. This was not verified in this research.

HOLD: Is there a connection between cleft palate and autism? 

Not researched. Do not publish an answer without a peer-reviewed or clinical-body source.

Conclusion

Early assessment, an individual treatment plan and coordinated follow-up give children with a cleft the best chance of eating, hearing and speaking well. If a scan or a birth has brought you here, the next step is to ask your obstetrician or paediatrician for a referral to a cleft team, and to ask that team about feeding, surgery timing and financial support. If your child has had a repair and you are worried about speech or nasal-sounding speech, a speech assessment can show what kind of help is needed.

This article is educational information and is not medical advice. Your child’s cleft team makes treatment decisions based on your child’s own assessment.