Published: July 21, 2026
Cleft lip and cleft palate are among the most common congenital craniofacial conditions, yet in Kentucky, many families have navigated fragmented care across multiple providers and systems to access the full spectrum of treatment.Andrea R. Hiller, M.D., pediatric plastic surgeon who recently joined Norton Children’s Surgery, affiliated with the UofL School of Medicine, is working to establish a multidisciplinary cleft clinic at Norton Children’s. Integrating dental, orthodontic, otolaryngology, speech-language pathology and social work services within a coordinated care model can greatly improve the patient experience.“Seeing these kids get to be the best version of themselves never gets old,” she said. “The transformation for the child, and for the family, is unlike anything else.”
According to Dr. Hiller, it is important for referring providers to understand that cleft treatment is not a single operative event; it spans infancy to late adolescence.“Most physicians don’t know the full longitudinal spectrum of cleft care,” she said. “They may not realize that prenatal consults are necessary, or that families need help anticipating and planning for years of care ahead.”Most patients are diagnosed with cleft lip and palate during the routine 20-week anatomy scan.“The goal is to get that mother into the office as soon as possible after the scan,” Dr. Hiller said. “Providing early reassurance and a clear road map makes an enormous difference for families.”During an initial prenatal consultation, Dr. Hiller walks families through the full scope of care ahead, from the surgical timeline to the multidisciplinary specialists who will be involved throughout the child’s treatment.The surgical timeline for cleft lip and palate is generally as follows:
After delivery, infants born with a cleft lip and palate frequently lack the ability to generate adequate intraoral suction for breastfeeding or standard bottle feeding. Patients typically require early interventions at birth, including specialized feeding devices, modified techniques and lactation support until the initial repair surgery takes place.Approximately 90% of children with cleft conditions also will require tympanostomy tubes, given the high prevalence of eustachian tube dysfunction in this patient population. Speech and language development is a primary clinical concern, emphasizing the importance of timely diagnosis — as delayed care can impair a child’s communication development.
Clinical advancements include the growing use of artificial intelligence (AI) technology and dynamic MRI in the evaluation of velopharyngeal insufficiency (VPI).“You can actually watch a child speak and observe how the palate moves. It makes diagnosis significantly easier,” Dr. Hiller said.
AI-driven speech analysis tools can evaluate recorded speech samples for VPI, which increases access to care for patients in more rural or traditionally underserved communities.Another commonly missed diagnosis is submucous cleft palate, where the musculature of the velum fails to fuse properly during fetal development. The absence of a visible mucosal defect means it frequently goes unidentified until a dentist or speech-language pathologist flags atypical speech patterns.
Dr. Hiller is a pediatric plastic surgeon with Norton Children’s Surgery. She earned her medical degree from the University of Louisville School of Medicine, completed an integrated plastic surgery residency at Penn State Milton S. Hershey Medical Center and a fellowship in adult and pediatric craniofacial surgery at Vanderbilt University Medical Center, Nashville, Tennessee. In addition to specializing in cleft lip and palate, Dr. Hiller treats a broad range of craniofacial conditions. She returns to her alma mater serving as an assistant professor, Division of Plastic and Reconstructive Surgery, UofL School of Medicine Department of Surgery.