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Building Your Care Team: The Multidisciplinary Approach

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At a Glance

Care for an isolated cleft palate requires a multidisciplinary team of specialists, including plastic surgeons, ENTs, audiologists, and speech therapists. This coordinated approach ensures comprehensive treatment from birth into early adulthood, managing surgery, speech, hearing, and dental health.

Key Takeaways

  • • Children with an isolated cleft palate require long-term care from a multidisciplinary team of specialists from birth into early adulthood.
  • • ACPA-approved teams ensure that your child's treatment is coordinated across all necessary medical, surgical, and developmental disciplines.
  • • A plastic surgeon repairs the palate, while ENTs and audiologists protect your child's hearing and manage frequent ear infections.
  • • Speech-language pathologists, pediatric dentists, and orthodontists support your child's communication and dental development as they grow.

Caring for a child with an isolated cleft palate is a journey that requires many different types of expertise. Because a cleft affects everything from breathing and feeding to hearing, speech, and dental development, it cannot be managed by a single doctor. Instead, care is provided by a multidisciplinary team—a group of specialists who work together to coordinate your child’s treatment from birth into their early twenties [1][2].

Why an ACPA-Approved Team Matters

The American Cleft Palate Craniofacial Association (ACPA) sets high standards for how cleft teams should operate. An ACPA-approved team is one that has demonstrated it has all the necessary specialists and a coordinated way of working together [1].

Research shows that children treated at centers with a high volume of cleft cases—like many ACPA-accredited centers—often have better outcomes, including fewer complications and shorter hospital stays [3]. These teams meet regularly to discuss each child’s progress, ensuring that a decision made by the surgeon also makes sense for the child’s speech development and dental growth [2].

Your Child’s Specialist Team

Each member of the team plays a specific role in your child’s care. For a child with an isolated cleft palate, the core members typically include:

The Surgical and Medical Experts

  • Plastic Surgeon: The surgeon’s primary role is the palatoplasty—the surgery to close the opening in the roof of the mouth and reposition the muscles to allow for normal speech [4]. They also monitor for any small openings that might remain (fistulae) or the need for secondary surgeries as the child grows [5].
  • Otolaryngologist (ENT): Children with cleft palate are at a much higher risk for fluid buildup in the ears and ear infections because the muscles of the palate also help open the Eustachian tubes [6][7]. The ENT may place small tubes (pressure equalization tubes) in the ears to protect the child’s hearing [7].
  • Audiologist: Working closely with the ENT, the audiologist performs regular hearing tests. Because clear hearing is vital for learning to speak, these checks are a cornerstone of early care [6][8].

The Communication and Growth Experts

  • Speech-Language Pathologist (SLP): The SLP monitors your baby’s early communication and helps determine if the palate is working correctly for speech. They check for velopharyngeal insufficiency (VPI)—a condition where air escapes through the nose during speech—and provide therapy or recommend surgical adjustments if needed [9][10].
  • Pediatric Dentist: They focus on “the now,” ensuring your child’s primary (baby) teeth stay healthy and managing any dental anomalies like extra or missing teeth, which are common in children with clefts [11][12].
  • Orthodontist: They focus on “the future.” As your child grows, the orthodontist monitors the growth of the jaws and the alignment of the permanent teeth. They often use braces or other appliances to correct malocclusions (misaligned bites) and may work with the surgeon if jaw surgery is needed in the teenage years [13][14].

A Marathon, Not a Sprint

It is helpful to remember that cleft care is a long-term commitment. While the most intensive period of surgery and feeding support happens in the first year or two, your team will stay with you through every developmental milestone [15][16]. From the first words in preschool to the final orthodontic adjustments in high school, this team is your partner in ensuring your child thrives [15]. Although the “burden of care” can feel heavy at times, staying connected to your team ensures your child receives the most up-to-date and coordinated treatment available [16][17].

Frequently Asked Questions

Why does my child need so many doctors for an isolated cleft palate?
A cleft palate affects breathing, feeding, hearing, speech, and dental development. Because no single doctor can manage all these areas, a coordinated team of specialists works together to provide comprehensive care as your child grows.
What is an ACPA-approved cleft team?
The American Cleft Palate Craniofacial Association (ACPA) approves teams that meet strict standards for specialized, coordinated care. Children treated at these high-volume centers often experience fewer complications and better overall outcomes.
How will the cleft team protect my baby's hearing?
Children with a cleft palate have a higher risk of ear fluid buildup and infections. An ENT may place small ear tubes to equalize pressure, while an audiologist performs regular hearing tests to ensure clear hearing, which is essential for speech development.
Will my child need speech therapy after cleft palate surgery?
Many children need support from a speech-language pathologist to ensure the repaired palate works correctly. The therapist checks for conditions like velopharyngeal insufficiency, where air escapes through the nose, and provides therapy or recommends surgical adjustments if needed.
How long will my child need to see the cleft care team?
Cleft care is a long-term commitment that typically lasts from birth into the early twenties. While intensive surgeries happen in the first few years, the team continues to manage speech, hearing, and orthodontic needs through childhood and adolescence.

Questions for Your Doctor

  • • Is this team specifically accredited by the American Cleft Palate Craniofacial Association (ACPA)?
  • • How many primary palate repairs does the surgeon on this team perform each year?
  • • Does the team hold regular 'team days' where my child can see all these specialists in a single visit?
  • • At what age will the orthodontist become more involved in my child's care, and how will they coordinate with the pediatric dentist?
  • • How does the team handle the transition of care as my child moves from childhood into their teenage years?
  • • Can you explain how the ENT and audiologist work together to monitor my baby’s hearing if they have frequent ear infections?

Questions for You

  • • How comfortable do you feel asking questions of the various specialists on the team?
  • • Are you prepared for a long-term care journey that will likely last until your child reaches early adulthood?
  • • What are your main goals for your child's speech and appearance as they grow up?
  • • How do you plan to manage the 'burden of care' (the time and travel needed for appointments) over the coming years?

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The Surgery Timeline: Repairing the Palate Gathering the Full Picture: Genetics and Associated Syndromes

References

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    Interdisciplinary Team Care for Children with Facial Differences.

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    Pediatric annals 2023; (52(1)):e18-e22 doi:10.3928/19382359-20221114-04.

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    The Effect of Teamwork on Children With Cleft Lip and Palate and Their Mother's Quality of Life.

    Khanchezar F, Moradi N, Tahmasebi Fard N, et al.

    The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association 2019; (56(10)):1353-1358 doi:10.1177/1055665619853749.

    PMID: 31184215
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    Cleft-Palate Repair: Does Hospital Case-Volume Impact Outcomes or Cost?

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    Plastic and reconstructive surgery 2018; (141(5)):1193-1200 doi:10.1097/PRS.0000000000004292.

    PMID: 29351184
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    Early Cleft Palate Repair is Associated With Lower Incidence of Velopharyngeal Insufficiency Surgery.

    Stanton EW, Rochlin D, Lorenz HP, Sheckter CC

    The Journal of craniofacial surgery 2025; (36(3)):781-785 doi:10.1097/SCS.0000000000010540.

    PMID: 39178397
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    What's New in Cleft Palate and Velopharyngeal Dysfunction Management: An Update.

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    Plastic and reconstructive surgery 2024; (154(2)):378e-390e doi:10.1097/PRS.0000000000011312.

    PMID: 39046844
  6. 6

    Exploring the relationship between conductive hearing loss and cleft speech characteristics in children born with cleft palate.

    Baker S, Wren Y, Zhao F, Cooper F

    International journal of pediatric otorhinolaryngology 2021; (148()):110820 doi:10.1016/j.ijporl.2021.110820.

    PMID: 34218052
  7. 7

    Comparison of Eustachian tube ventilation function between cleft palate and normal patients using sonotubometry.

    Widodo DW, Hisyam A, Alviandi W, Mansyur M

    JPRAS open 2021; (29()):32-40 doi:10.1016/j.jpra.2021.04.003.

    PMID: 34036142
  8. 8

    The role of the tensor veli palatini muscle in the development of cleft palate-associated middle ear problems.

    Heidsieck DS, Smarius BJ, Oomen KP, Breugem CC

    Clinical oral investigations 2016; (20(7)):1389-401 doi:10.1007/s00784-016-1828-x.

    PMID: 27153847
  9. 9

    Speech Results in 10-Year-Old Children With Isolated Cleft Palate.

    Evakoski T, Szwedyc A, Leikola J, et al.

    The Journal of craniofacial surgery 2025; doi:10.1097/SCS.0000000000012215.

    PMID: 41335501
  10. 10

    The Implications of Nasal Substitutions in the Early Phonology of Toddlers With Repaired Cleft Palate.

    Hardin-Jones MA, Chapman KL

    The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association 2018; (55(9)):1258-1266 doi:10.1177/1055665618767421.

    PMID: 29624438
  11. 11

    Fetal Cleft Lip and Palate.

    Sanders W, Teper J, Muller R, Obican S

    Obstetrics and gynecology 2026; doi:10.1097/AOG.0000000000006223.

    PMID: 41712928
  12. 12

    Dental anomalies frequency in submucous cleft palate versus complete cleft palate.

    Schwartz JP, Garib DG

    European journal of orthodontics 2021; (43(4)):394-398 doi:10.1093/ejo/cjab003.

    PMID: 33615332
  13. 13

    Craniofacial Cephalometric Morphology in Caucasian Adult Patients with Cleft Palate Only (CPO).

    Zawiślak A, Wędrychowska-Szulc B, Grocholewicz K, Janiszewska-Olszowska J

    Diagnostics (Basel, Switzerland) 2023; (13(12)) doi:10.3390/diagnostics13122058.

    PMID: 37370953
  14. 14

    Craniofacial Cephalometric Morphology in Polish Adolescents with Cleft Palate Only.

    Zawiślak A, Wędrychowska-Szulc B, Grocholewicz K, Janiszewska-Olszowska J

    Journal of clinical medicine 2024; (13(15)) doi:10.3390/jcm13154507.

    PMID: 39124773
  15. 15

    Evaluation of Discipline-Specific Outcomes Through a Multidisciplinary Team Clinic for Patients With Isolated Cleft Palate.

    Trivedi PB, Padovano WM, Skolnick GB, et al.

    The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association 2021; (58(12)):1517-1525 doi:10.1177/1055665621990174.

    PMID: 33535807
  16. 16

    Orthodontic-Surgical Approach for Treating Skeletal Class III Malocclusion With Severe Maxillary Deficiency in Isolated Cleft Palate.

    Nakatsugawa K, Kurosaka H, Mihara K, et al.

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  17. 17

    Malocclusion in Children Aged 8 to 10 Years Old With Operated Isolated Cleft Palate.

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This page is for educational purposes only and does not replace professional medical advice. Always consult your child's multidisciplinary cleft care team regarding specific treatment and developmental plans.

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