The Role of Speech Therapy in Post-Surgical Cleft Lip Recovery

By Abbie Affum. 

Editor: Elena Bobric

When we think about cleft lip treatment, surgery often comes to mind first. Surgical repair is essential, but it is not the end of the recovery process. For many children, additional support is required to develop clear speech. This is where speech therapy becomes vital, as it transforms surgical outcomes into long-term communication skills (Kummer, 2020).

A cleft lip is a congenital condition where the tissue forming the upper lip fails to fully join during fetal development, resulting in a visible gap or opening (Cleveland Clinic, 2023). This separation can range from a small notch to a deep split that extends into the nose and gums, often affecting feeding, speech, and emotional well-being.

Figure 1. Medical illustration of cleft lip anatomy. Source: Nhan Tam Dental Clinic (n.d.).

A cleft lip affects more than appearance and also disrupts the development of the oral and facial muscles. These disruptions can interfere with articulation and airflow, making it difficult for children to produce certain sounds even after surgical repair. Studies indicate that a significant percentage of children with cleft lip and palate continue to experience speech problems postoperatively, including articulation errors, hypernasality, and reduced intelligibility (Persson et al., 2021; Sell et al., 2015). Without intervention, such difficulties may persist into school years, impacting both academic and social development.

Speech therapy bridges the gap between surgical repair and functional recovery. Therapists work with children to re-establish correct articulatory placement, strengthen oral motor control, and improve resonance to reduce nasal speech. Interventions also address maladaptive compensatory speech behaviors, such as glottal stops, that may develop before or after surgery (Peterson-Falzone et al., 2017). Importantly, therapy often extends beyond clinical sessions, as parents and caregivers are taught techniques to reinforce progress at home, creating consistent opportunities for practice (American Speech-Language-Hearing Association [ASHA], n.d.).

The long-term benefits of consistent speech therapy extend well beyond pronunciation. Clear communication supports literacy skills, classroom participation, and academic success (Hardin-Jones & Chapman, 2014). Children who receive therapy are also more likely to experience positive peer interactions and reduced stigma associated with cleft conditions, fostering stronger social and emotional well-being (Stock & Rumsey, 2015). In some cases, early and intensive therapy has been shown to reduce the need for secondary surgical interventions, further emphasizing its importance in comprehensive care (Campbell et al., 2021).

Despite its proven benefits, access to speech therapy remains deeply uneven worldwide. In many low-resource regions, families In many regions, families must travel long distances to find trained specialists, while others may not have access at all (Callahan et al., 2019).. Additionally, they may also not only lack trained specialists but also have limited awareness of speech therapy as a necessary part of cleft care. These disparities are shaped by workforce shortages, geographic isolation, and systemic inequities in healthcare infrastructure (EquityHealthJ, 2022). In many low-resource countries, access to speech therapy is not only limited but also virtually nonexistent. For example, Ethiopia has an estimated one speech-language pathologist (SLP) per 800,000 people, far below the World Health Organization’s recommended ratio of 1 per 100,000 (SpeechTherapy.org, 2022). In such regions, families may not even be aware that speech therapy exists, let alone have access to trained professionals. Global health initiatives now emphasize the need to integrate speech therapy into cleft care programs, expand training opportunities for local providers, and adopt telehealth models to reach underserved populations (Bruneel et al., 2020). Addressing these disparities is critical to ensuring that all children can achieve functional recovery, not just structural repair.

In conclusion, while surgery repairs the lip, speech therapy restores the voice. Together, they complete the recovery journey by giving children both the appearance of a new smile and the ability to share it confidently with the world. Recognizing and expanding access to speech therapy ensures that cleft lip care empowers children not only to heal, but also to communicate, connect, and thrive.

References

American Speech-Language-Hearing Association. (n.d.). Cleft lip and palate. ASHA Practice Portal. https://www.asha.org/practice-portal/clinical-topics/cleft-lip-and-palate/

Alighieri, C., Bettens, K., Bruneel, L., D'haeseleer, E., Van Gaever, E., & Van Lierde, K. (2020). Effectiveness of Speech Intervention in Patients With a Cleft Palate: Comparison of Motor-Phonetic Versus Linguistic-Phonological Speech Approaches. Journal of speech, language, and hearing research : JSLHR, 63(12), 3909–3933. https://doi.org/10.1044/2020_JSLHR-20-00129

Campbell, A., Restrepo, C., Rogers, M., Farkas, L., & Marcus, J. (2021). Secondary speech surgery rates after cleft palate repair: A systematic review. Plastic and Reconstructive Surgery Global Open, 9(2), e3402. https://doi.org/10.1097/GOX.0000000000003402

Cleveland Clinic. (2023, October 1). Cleft lip & cleft palate: Causes & treatment. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/10947-cleft-lip-cleft-palate

EquityHealthJ. (2022). Emerging professional practices focusing on reducing inequity in speech-language therapy. International Journal for Equity in Health. https://equityhealthj.biomedcentral.com/articles/10.1186/s12939-022-01815-0

Hillary L. Broder, Maureen Wilson-Genderson, and Lacey Sischo: Health Disparities Among Children With Cleft American Journal of Public Health 102, 828_830 https://doi.org/10.2105/AJPH.2012.300654

Hardin-Jones, M., & Chapman, K. L. (2014). The impact of cleft lip and palate on speech and language development. Facial Plastic Surgery Clinics of North America, 22(4), 493–500. https://doi.org/10.1016/j.fsc.2014.08.004

Kummer, Ann W. Cleft Palate and Craniofacial Conditions : A Comprehensive Guide to Clinical Management. Fourth edition. Burlington, Massachusetts: Jones & Bartlett Learning, 2020. Print.

Nhan Tam Dental Clinic. (n.d.). Cleft lip and cleft palate – Things you need to know. https://nhantamdental.com/cleft-lip-and-cleft-palate-things-you-need-to-know-205.html

Persson, C., Elander, A., Lohmander-Agerskov, A., & Söderpalm, E. (2002). Speech outcomes in isolated cleft palate: impact of cleft extent and additional malformations. The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association, 39(4), 397–408. https://doi.org/10.1597/1545-1569_2002_039_0397_soiicp_2.0.co_2

Peterson-Falzone, S. J., Trost-Cardamone, J. E., Karnell, M. P., & Hardin-Jones, M. (2017). The clinician’s guide to treating cleft palate speech. Mosby Elsevier.

Sell, D., Mildinhall, S., Albery, L., Wills, A. K., Sandy, J. R., & Ness, A. R. (2015). The speech outcomes of cleft palate repair in the United Kingdom: Results from the Cleft Care UK study. Cleft Palate-Craniofacial Journal, 52(6), 597–608. https://doi.org/10.1597/14-178

Stock, N. M., & Feragen, K. B. (2016). Psychological adjustment to cleft lip and/or palate: A narrative review of the literature. Psychology & health, 31(7), 777–813. https://doi.org/10.1080/08870446.2016.1143944