Orientation
Typical courses from birth to adulthood – as timelines. Every course is individual.
The following timelines show typical treatment courses for some common diagnoses. They are for orientation. The actual course – timing, order and type of procedures – is always determined individually at the specialised centre and may differ markedly.
Presentation at the specialised centre, feeding advice, palatal plate if needed.
Surgical closure of the lip (timing depends on centre and child).
Surgical closure of the palate; important for speech and hearing.
Regular check-ups; speech therapy if needed.
Bone reconstruction in the alveolar cleft (if the jaw is involved).
Tooth/jaw alignment; orthodontic-surgical measures if needed.
Nose or scar corrections after growth is complete, if needed.
Clinical assessment of head shape; imaging if needed.
Possible early in suitable forms, usually with subsequent helmet therapy.
Alternative, depending on form and time of diagnosis.
Monitoring of head shape, development and – where needed – intracranial pressure.
Positioning; if needed a nasopharyngeal tube, respiratory support; distraction in severe cases. Individual team decision.
Ensuring feeding (special bottles, tube if needed), monitoring of breathing.
If a cleft palate is present.
Lower-jaw growth, speech and hearing checks.
Interdisciplinary assessment; securing breathing and eye protection.
e.g. fronto-orbital advancement to give the brain space.
Gradual advancement of the midface if needed.
e.g. jaw, nose; in Apert syndrome also the hands.
For cleft lip and palate, structured outcome monitoring has become established internationally. The ICHOM Standard Set for Cleft Lip & Palate recommends recording treatment outcomes at defined ages – typically around 5, 8, 10 and 12 years and in young adulthood (about 18–22 years) – in a standardised way. Areas assessed include:
Such uniform monitoring makes it possible to track outcomes over time and compare them between centres – an important contribution to quality assurance.
Basis: This overview follows the current German S3 guideline on cleft lip and palate therapy (AWMF reg. no. 007-038, 2025), established recommendations for the treatment of craniosynostosis, and the ICHOM Standard Set for Cleft Lip & Palate. The stated time points are typical reference values and vary by treatment concept, centre and individual findings. Further sources can be found in the craniofacial library.