Protocol-guided systematic management of the cleft lip and palate patient is well-accepted and this is regularly presented as various interventions required during various epochs of the growing years of the CLP patient. Adherence to this from the time of infancy, is regarded as necessary for best outcomes at the time of achievement of full maturity. In reality, in many parts of the world where cleft lip and palate still make up a significant reconstructive burden, and where short-term surgical delivery of repairs by visiting teams provide the mainstay of care, this comprehensive protocol-guided care from infancy to maturity is often either non-existent or unsustained, leaving patients partially rehabilitated. This presentation aims to illustrate, by means of the classic board game of Snakes and Ladders, how challenges can be overcome, in looking after these patients and helping them achieve a range of end-points, which while aspiring towards optimal outcomes, may also need to include surrogate results.

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