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Cleft Lip and Cleft Palate

Cleft lip and palate are birth defects that occur very early in your baby's development during pregnancy. Clefting occurs when there is not enough tissue in the mouth or palate and the available tissues don't fuse together normally during fetal development. Cleft lip and palate is the fourth most common type of birth defect in the United States.

Symptoms

A cleft lip is characterized by a narrow opening or gap in the skin of the upper lip that extends to the base of the nose. This split often extends beyond the base of the nose and includes the upper jaw and/or upper gum. Although much less common, it can also appear as a bilateral cleft lip, which involves two wide gaps in the upper lip and a collapsed and stretched nose. The majority of cleft lips occur with a cleft palate.

A cleft palate is a split or opening in the roof of the mouth and the nasal cavity that can involve the front of the palate or both the front and back. It can only be seen when the baby's mouth is open.

A cleft lip and palate can occur on one or both sides of the mouth. Some babies will have both a cleft lip and cleft palate or just one or the other.

A combined cleft lip and palate is more common among males while females are more likely to get cleft palate alone. The incidence of cleft lip with or without cleft palate is about one in 1,000 births. While the malformation occurs in all races, it is twice as common in Asians and about half as common in African Americans. Approximately one baby in every 2,000 births has a cleft palate without a cleft lip.

What causes cleft lip and palate?

In the majority of cases, the cause of cleft lip and cleft palate is unknown. Experts believe they occur as a result of a combination of genetic and environmental factors. In some cases cleft lip and palate have a genetic component, however, a gene has not been identified. More than 40 percent of cleft palates are associated with malformation syndromes such as van der Woude sndrome for cleft lip and velocardiofacial syndrome for cleft palate. Approximately 60 percent of cleft lips and palates are not linked to incidents or lifestyle during pregnancy except in a few exceptions:

You are at greater risk of having a child with clefting if:

  • One of the parents has clefting.
  • The parents have already had one child with clefting.
  • A parent and child in your family have clefting.
  • If parent or other child has both a cleft lip and palate.

Treatment

The medical care for a child with cleft involves a complex and long-term plan of care that will involve a series of surgeries that stretches to adulthood. Our craniofacial surgery team will work closely with you and your child to develop a plan that requires the least interventions and provides the best results for your child. Although treatment for a cleft lip and/or cleft palate may extend over several years and require several surgeries depending upon the severity of the condition, most children affected by this condition can achieve normal appearance, speech and eating abilites.

Cleft lip

Repair of a cleft lip may need one or two surgeries depending on the extent of the malformation. The first surgery is usually performed when your baby is about 3 months old. This surgery involves moving the skin, muscle and lining in the proper place. The nose may also be shaped to improve its form.

Cleft palate

The initial surgery usually occurs when your baby is between 9 and 12 months old. This first surgery creates a functional palate, which reduces the chances that fluid will develop in the middle ears, and allows for the proper development of speech.

Your child may also need a bone graft at about 8 years old to fill in the upper gum line so that it can support permanent teeth and stabilize the upper jaw. Further surgeries to help improve speech are required by about 20 percent of children with a cleft palate. Braces may also be needed to straighten the teeth.

Additional surgeries to improve the appearance of the lip and nose, close openings between the mouth and nose, help breathing, and stabilize and realign the jaw may also be performed.

The following outlines a general care and treatment plan, but is not all-inclusive, nor applicable to every child.

Prenatal

Birth to 1 month

  • Evaluation by our craniofacial team.
  • Diagnosis and genetic counseling provided.
  • Psychosocial issues addressed.
  • Feeding instructions provided and growth monitored.

1 to 4 months

  • Feeding and growth monitored.
  • Cleft lip repaired.
  • Ears and hearing checked.

5 to 15 months

  • Feeding, growth and development checked.
  • Ears and hearing checked; ear tubes may be required.
  • Cleft palate repaired.
  • Oral hygiene instructions provided.

16 to 24 months

  • Ears and hearing assessed.
  • Speech and language evaluated.
  • Development assessed.

2 to 5 years

  • Speech and language assessed; velopharyngeal insufficiency managed.
  • Ears and hearing checked.
  • Lip and nose revision may be considered.
  • Development and psychosocial adjustment evaluated.

6 to 11 years

  • Orthodontic interventions performed.
  • Speech and language assessed; velopharyngeal insufficiency managed.
  • Alveolar bone graft done.
  • School/psychosocial adjustment assessed.

12 to 21 years

  • Jaw surgery and rhinoplasty performed, if needed.
  • Orthodontic bridges and implants provided, if needed.
  • Genetic counseling provided.
  • School/psychosocial development assessed.

 

 

 

 

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