Who Does What, and When: Mateo's Care Timeline

Here are the real care steps for complete unilateral CL/P, each with the timing the library gives. Notice that every when is tied to a stage of growth, not a calendar date. Nasoalveolar molding (orthodontist and feeding team) in the first weeks of life, to narrow the gap and shape the nose before surgery. Lip repair / cheiloplasty (craniofacial surgeon) at about 3 to 6 months. Palate repair / palatoplasty (craniofacial surgeon) at about 10 to 14 months, because delay worsens speech. Ear tubes and hearing checks (ENT and audiologist) often beginning at palate repair and then ongoing, because middle-ear fluid is near-universal and mostly appears after birth. Speech assessment and possible VPI surgery (speech-language pathologist and surgeon) from preschool to school age, when VPI shows once the child is talking. Alveolar bone graft (oral surgeon and orthodontist) in the mixed dentition, ideally before age 9, since graft success is about 86 percent and age over 9 is the main failure predictor. Definitive septorhinoplasty and, if needed, orthognathic surgery (craniofacial surgeon and orthodontist) at skeletal maturity in the teen years, after the face stops growing.

Two simple rules explain every when. The rule of growth: a structure is repaired at the age when the repair helps the most and harms growth the least. Lip and palate are closed in infancy so feeding, hearing, and speech can develop; the bone graft waits for the mixed dentition so the canine can erupt into it; the nose and bite are finished in the teens, after the face stops growing. The rule of surveillance: some problems are not fixed once but watched for years. Hearing and middle-ear fluid are rechecked again and again, and speech is monitored as the child learns to talk. One honesty note: timing is not equal for everyone, since minority and non-English-speaking children have measurable delays reaching cleft surgery in some US settings, which is an access point, not a biology point.