Cleft & Craniofacial Surgery: A Complete Guide for Parents and Patients

In most cases, a combination of genetics and environment — and often no single identifiable cause at all. Family history plays a role, and factors during pregnancy such as smoking, certain medications, and diabetes have been linked to a somewhat higher chance. But the most important thing for parents to hear is this: a cleft is not your fault. The tissues simply did not finish fusing in the first weeks of pregnancy, usually before anyone knew the pregnancy existed. A genetics consultation — part of standard cleft team care — can tell you whether the cleft is isolated or part of a broader condition.

There is no single number, and any surgeon who promises one is guessing. A child with a cleft lip alone may need just one or two operations. A child with a complete cleft lip and palate typically has the lip repair, the palate repair, and an alveolar bone graft — three core operations — and some children also need a speech procedure, jaw surgery in the teen years, or a lip and nose refinement. At each stage, the team recommends surgery only when it protects a real milestone, never by default.

Most children do. The palate repair is deliberately timed before speech develops — usually by 18 months — so the muscles of the palate can power normal speech sounds from the start. The clear majority of children develop understandable, age-appropriate speech with the help of speech therapy along the way. Published reviews show that roughly one in five children needs an additional operation later to improve speech (for a condition called velopharyngeal insufficiency, or VPI) — and when it is needed, it works well. Your child's speech is monitored by the team at every visit, so nothing is left to chance.

Yes — honesty matters here. Any incision on the skin leaves a scar, and cleft lip repair is no exception. The good news: the repair is designed so the scar sits within the natural lines of the lip, it fades substantially over the first one to two years, and small revisions later in childhood or adolescence can soften it further. Most repaired clefts are far less noticeable than parents fear, and many are hard to spot in everyday life.

In nearly all cases, yes. Cleft repair is reconstructive treatment of a congenital (present-at-birth) condition, not cosmetic surgery, and it is typically covered by medical insurance — many states also mandate coverage for cleft-related care. Pre-authorization is standard, and our team handles that paperwork with you, in English or Spanish.

Dr. Calleja is a board-certified oral and maxillofacial surgeon (American Board of Oral and Maxillofacial Surgery) who then completed a dedicated fellowship in Cleft & Craniomaxillofacial Surgery at Charleston Area Medical Center Children's Hospital — an additional year of training focused entirely on cleft and craniofacial care. This is his signature specialty. He has also repaired clefts on surgical mission trips in Kenya and Guatemala, caring for children who would otherwise never receive treatment.

Absolutely — and this is more common than people realize. Adults who never completed their cleft journey, or whose repairs were done decades ago with older techniques, can benefit from modern bone grafting, jaw surgery, fistula repair, speech surgery, and lip or nose revision. Age is not a barrier; Dr. Calleja evaluates adult cleft patients regularly.

Consultations and follow-up care take place at the Waldorf and California, Maryland offices; the operations themselves are performed in a hospital setting with pediatric anesthesia teams. Dr. Calleja is fully bilingual — Spanish-speaking families hear every explanation, ask every question, and read every instruction in their own language, without an interpreter in the middle.