Background: Complete and comprehensive management of a cleft patient goes beyond surgical repairs. However, certain challenges may limit total rehabilitation. This study intends to highlight specific challenges to optimal care for Orofacial cleft patients in the West African subregion and to suggest possible solution.Methods: This is a cross sectional study carried out at two tertiary hospitals in Nigeria from January 2012 to December 2014. Cleft lip/palate patients were recruited from regular surgical outpatient clinics and during special surgical outreaches organized by the cleft teams of these hospitals. Consent was obtained from all participants (i.e. self or parental consent). In order to execute an inquiry into the challenges to effective care, a comprehensive preformed was drawn to elicit and record patients' and parents' bio-data, relevant history and clinical information as well as patients' perceived treatment needs and desired treatment outcomes. Separate inquiries were made to determine the professional group composition of the multidisciplinary cleft team in each hospital, available cleft care services in each hospital, and the treatment protocols observed by each cleft team. The data gathered were analyzed to determine the challenges to optimal care for the cleft patient.Results: Two-hundred and twenty-eight (228) patients were recruited of whom 57 (25%) were encountered during special surgical outreach programs. Patients' age range was between three weeks and thirty -six years. Observed challenges to optimal care are presented under four considerations namely; "Patient related", "Cleft team related", "Hospital related" and "Outcome related" Considerations. Broadly, the challenges include late presentation, high attrition rate, cleft teams' deficiencies in key specialty services (e.g. orthodontics, and speech therapy), and competing non cleft workload of the cleft team members. Conclusion:Poor awareness, ignorance and financial difficulties accounted mostly for late presentation. Other barriers such as inadequacies of multidisciplinary cleft care services and required facilities in the hospitals were quite limiting. In order to mitigate the challenges, public re-orientation and patient education, infrastructural support, increased funding and training of essential personnel in the full range of skills for cleft care is imperative.