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During pregnancy if the facial development is affected somehow, cleft lip and palate develops. This anomaly may vary from a minimal notch in one side to a wide cleft that is present in both sides of the lip. Our team has the clinical experience to treat both the minimal deformities and the whole phases of deformities affecting the facial skeleton as well. There are multifactorial causes in their etiology. It is known that in 4th-7th weeks and 7th-12th weeks of intrauterine life, lip and palate structures develop, respectively. According to different exposure circumstances, variable types of cleft lip-palate can be seen at different stages of intrauterine life. It can be seen as isolated cleft lip or isolated cleft palate, as well as part of syndromes or with other additional anomalies. The classification of cleft lip and palate deformity, whose etiology and cytogenetics are quite different, can be a wide range of forms in terms of genetics and surgery. To the best of our knowledge, it is accepted that the cleft in each baby is unique and it will be the most appropriate method to treat it with an individualized plan and team approach. The team dealing with the treatment of cleft lip and palate can work in multidisciplinary and interdisciplinary. Patients naturally benefit from the teams working in harmony. Plastic, Reconstructive and Aesthetic Surgery, Speech-Language Therapy and Orthodontics units compose the core of the team. In other words, ''must for treatment''. Specialists from many disciplines are added to the team at different times of treatment. These are; Anesthesia, Nursing, Ear-Nose-Throat (ENT), Audiology, Obstetrics, Pediatrics, Genetics, Pediatric Cardiology, Pediatric Neurology, Pediatric Surgery, Neurosurgery, Cardiovascular Surgery, Psychology, Psychiatry, Pedodontics, Prosthetics, Social Services and together with these, it composes a team for the diagnosis and treatment of these clefts. They work together to identify the needs of children and to consider appropriate treatment that provides the appearance, speech, hearing and psycho-social development of their healthy peers at as early an age as possible. The "Cleft Lip-Palate Meeting" is held every Monday morning for this purpose.

Specialists and residents of Department of Plastic Reconstructive and Aesthetic Surgery, with the Orthodontic Unit of Dentistry, Audiology and Speech Therapy Unit, Otolaryngology Department and Developmental Specialist of Pediatric Psychology for the cleft team for long standing management in treatment of these deformities.

Department of Plastic, Reconstructive and Aesthetic Surgery is the unit that patients primarily apply for the treatment, and this team is responsible for organize the proper management. Challenging and difficult patients are discussed in the meetings for cleft lip/palate and craniomaxillofacial disorders every week with the extended team and options are searched for the treatment.

Our entire surgical team has clinical experience that can treat all stages of deformities, including varies from the notch on the lip to the deformities of facial skeleton. Furthermore, the success of surgical treatment in the treatment of these patients, cooperation with other disciplines will carry the treatment success to higher levels. Patients will be given lifelong medical and surgical support as long as they wish. Therefore, we wish to continue their follow-up regularly until adulthood. In the management of cleft and related deformities our specialists are one the bests in their area of expertise. They are well informed about treatment of cleft, related anomalies, associated syndromes and probable complications that may have happen throughout the treatment and they train the residents concerning these issues.

Hacettepe University Department of Plastic, Reconstructive and Aesthetic Surgery is the leader and reference center of our region for 55 years. Every year more than 1000 infant, toddler and teenagers are evaluated from specialist of different expertise and around 600 - 800 of them are operated.



The advancement in the technology (high resolution ultrasonography, genetic tests) provides new opportunities for prenatal diagnosis. Prenatal counselling may help the parents to describe child's condition, treatment options and clarifying the expectations. When cleft lip and palate deformity is diagnosed during pregnancy, informing the parents about what will happen to them after birth is essential by the Plastic, Reconstructive and Aesthetic Surgeon. It is necessary to improve the state of mind of the pregnant woman in this meeting and to inform about the cleft condition of the baby and postnatal nutrition. It is informed that if the pregnancy ends on time, the baby's birth weight and development will be better, care of the newborn will be easier and the importance of breastfeeding for newborn is also explained to the parents.

The ideal timing in the early evaluation of the patient is the first two weeks or the next days when the state of health is appropriate.

When the patient is referred to the Cleft Center by the pediatrician, the team leader determines the proper treatment plan for the baby. If necessary, the child is referred to pediatrician, nutritionist, cardiologist, genetics, neurologist, psychiatrist and the inputs are evaluated by the cleft team on your behalf.

Depending on the severity of the cleft, your hometown, and your suitability for the treatment, the nasoalveolar molding, which we call preoperative orthodontic treatment, is scheduled and applied.

The specialists decide on the overall diagnosis and treatment together in multidisciplinary fashion. The parents and the patient are informed in detail.

During the follow up, the team coordinator provides the collaboration between the patient, you and the cleft team. The coordinator sets the appointments, answers the questions and coordinates the care for your child.


The specialist of the cleft team has been educated to have the full perspective to evaluate the patient from different aspects as it is necessary in the long term follow up of cleft patients. Because of there is a need for different specialties to approach problems from different point of views, The Craniomaxillofacial Cleft Center includes various healthcare professionals.

Different surgical-orthodontic-speech treatments may be required in the later stages of individuals with cleft lip and palate. Distraction and / or surgeries may be applied to the maxilla and mandible at different times. Our specialists working on this issue make meetings and treatment plans every week in cooperation with orthodontics. Patients who are followed up at our center at regular intervals are evaluated in terms of secondary surgical procedures such as lip revision, cleft lip nose, fistula and velopharyngeal insufficiency. Alveolar bone grafting, orthognathic surgery, rhinoplasty for cleft nose deformity are considered and their operations are scheduled

Treatment of head shape abnormalities (Craniosynostosis), vascular anomalies, craniofacial clefts and hypertelorbitism and miscellaneous craniofacial conditions such as fibrous dysplasia, Moebius Syndrome, Romberg Syndrome, Treacher Collins Syndrome and Neurofibromatosis are required also a specialty. Our specialists working on this fields also organize meetings and surgeries with neurosurgery.

Pierre Robin Sequence (PRS)

It is a clinical feature characterized by smallness in the jaw, positioning the tongue back to the airway and obstruction of the airway. PRS is usually accompanied by cleft palate. This clinical picture is included in many syndromes.

In these patients; In addition to breathing difficulties, swallowing problems, low oral intake, feeding time longer than 30 minutes, fatigue, cough, vomiting, bronchial aspiration, pause / delay in development and growth are observed.

The treatment requires a multidisciplinary approach and treatment begins with airway evaluation. The aim is to provide a safe airway. Among the treatments that can be applied are; pron positioning, oxygen therapy, continuous positive airway pressure (CPAP), intubation, tongue lip adhesion, tracheostomy, and mandibular distraction osteogenesis.

Treacher Collins Syndrome

Treacher Collins Syndrome (TCS) is congenital development disorder characterized by developmental retardation in the cheekbone, lower and upper jaw, anomalies around the eyes, cleft palate, hearing loss.

Obstetric ultrasonography can help in diagnosis due to the characteristic facial features of the syndrome. Prenatal diagnosis will help inform the family before birth and prepare them psychologically.

In the treatment of children born with this syndrome, multidisciplinary teamwork is required due to its many anomalies and complexity. In addition to the craniofacial plastic surgeon; ophthalmologist, otolaryngologist, speech pathologist, audiologist, orthodontist, genetic diseases specialist, pediatricians should be on the team. Patient and family counseling is key because these patients will undergo many surgical interventions starting from childhood to adulthood.

Orthognathic surgery

For a healthy mouth structure and bite, interventions to the lower and upper jaw bones, and the advancement and regression of the lower and upper jaw bones are called orthognathic surgery.

With the support of the orthodontics department before and after this surgical treatment, the positions of the teeth are individually shaped and the treatment is completed.

Cleft Lip-Nose Deformity (CLN)

The cleft lip nose deformity is present in all cleft lip forms whether or not accompanied by cleft palate. The degree of nasal deformity parallels the severity of the cleft lip. Even on the minimicroform cleft lip, there is a nose abnormality that becomes more evident over time. Nasal deformity is worse when there is alveolar and cleft palate.

After the facial development of the patient is completed (usually around the age of 18), cleft rhinoplasty is performed. The applied rhinoplasty should be featured and accompanying maxillary regression and alveolar cleft should be considered.


Audiologists: Audiologists evaluate the speech and hearing and with the ENT specialists they treat the hearing problems and middle ear effusions related with these deformities.

Speech Therapists: Speech therapists helps the team in determining the correct timing for surgical, orthodontic and therapeutic interventions to make the speech better. They help the nutritionists in treatment of feeding disorders secondary to craniofacial deformities and parental counselling.

Dentists: Pedodontics help the treatment of many pediatric dental problems of cleft patients. They control the preoperative and postoperative dental follow up.

Orthodontists: Orthodontists coordinate the cleft team in providing the appropriate dental alignment and jaw development with surgeons and other specialists. Orthodontists of our team work in collaboration with us in all aspects. They prepare the patient for surgical correction using a technique named ‘nasoalveolar molding ’ . This approach also minimizes the problems that the baby may experience until the surgical correction of the cleft. They also have an essential role in the follow up of the cleft patients.

Prosthodontists: For cases that surgical correction is not possible they provide the necessary prosthetic devices and work in coordination with both dentists and surgeons.

Genetic Specialists: They take the family history. Pediatric genetic specialists re-evaluate the history and examine the patient and family and help in the counselling. They also give counselling about the next pregnancies.

Nurses: They are specially trained for pediatric patient care. They monitorize the development of every patient and help the clinicians in every step. They are not only helping in the individual patient care they also help the overall turnover of the ward. They both act in the preoperative and the postoperative setting.

Plastic, Reconstructive and Aesthetic Surgeons: Surgeons are specialized in the treatment of cleft and related deformities from the infancy to adolescence. The surgical procedures optimize the function and outlook of the patients. Surgical procedures are planned in the growth a developmental period to provide the best result and ideal outcome. They work with the cleft team to reach to goal of providing function, and proper outlook of the face, palate and glance and speech and hearing.

Otolaryngologists: They are the specialists dealing with the obstructive airway problems, hearing loss, ear infections, allergic sinus and nasal problems of cleft patients. They work in collaboration with the other members of the cleft team in treatment of sleep, hearing, speech and nutritional problems.

Pediatrists: Pediatricians of the cleft team are trained for general follow up of the patients and providing the special needs of the ones with congenital anomalies.

Psychiatrists: They are responsible for providing the psychosocial adaptation and development including the behavioural and emotional functions. They also provide the necessary counselling for the patient’s family about these issues.

Social Workers: They help the patients and their family when an unexpected situation happens.

Family Committee: Family committee provide the connection and support between the families of the cleft patients. Committee consists of families having experience about the stressful conditions of the cleft patients (This committee is not yet active but it will be in the close future).


Pediatricians, obstetricians, other healthcare specialists, families and patients may be in contact with the cleft and craniomaxillofacial unit.

Team Coordinator



Phone: +90312 310 98 08, +90312 305 17 98, +90312 305 06 73, +90530 516 80 10

Department of Plastic, Reconstructive and Aesthetic Surgery




Department of Plastic, Reconstructive and Aesthetic Surgery

Hacettepe University Faculty of Medicine

Samanpazari, 06100, Ankara, TURKEY

Hacettepe University Cleft and Craniomaxillofacial Unit is listed in the International Team List of the American Cleft Palate-Craniofacial Association