Cleft lip and palate

Overview

Cleft lip and palate is a birth defect caused when the upper lip and the roof of the mouth, called the palate, fail to form completely during early fetal development, between the fifth and ninth week of pregnancy. This causes a gap, called a cleft, in the palate and on one or both sides of the upper lip. Clefting can occur in other parts of the face as well.

It's also possible for children to be born with a cleft lip only or a cleft palate only.

No one knows exactly why clefts occur, but some families may have a predisposition to them: If one parent or a child in a family has a cleft, the chances of a subsequent child being born with a cleft increases from the usual one in 600 to about one in 20. Having a child with a cleft doesn't mean that either parent did anything wrong during the pregnancy.

Signs & symptoms

Clefts of the lip and palate are the most common birth defects affecting the face, found in about one out of every 600 newborns. They're more common among Asians — affecting about one out of every 500 births — and least common among African-Americans, found in about one in every 2,000 newborns.

A cleft lip and palate is noted at birth by the presence of a cleft in the upper lip, either on one or both sides of the lip, together with a cleft in the palate.

A cleft palate can be open and obvious, or it may be covered by the lining or mucous membrane of the palate. The latter is known as a submucous cleft and isn't visible to the naked eye.

The condition can cause problems with feeding and speech, as well as ear infections and dental problems. Surgery is needed to repair the lip and palate.

Diagnosis

Cleft lip and palate is diagnosed by physical examination at birth, although high-resolution prenatal ultrasound may reveal the presence of a cleft lip in the womb. A cleft palate usually isn't detectable by ultrasound.

Because a submucous cleft palate isn't visible to the naked eye, this type of cleft palate may not be identified at birth, but may be diagnosed later if the child experiences swallowing or speech difficulties.

Treatment

An infant with cleft lip and palate can't suck properly, making breastfeeding difficult or impossible. Most babies will need to be bottle fed, with breast milk or formula, using special nipples. You may need to try a variety of nipples and bottles to find what works best for your baby. A nurse from the Craniofacial Anomalies Center will meet with you as soon as possible after your baby's birth to develop a successful feeding plan. It's important for your child's pediatrician to perform weekly weight checks to make sure your child is gaining enough weight.

Soon after birth and in preparation for surgery, the cleft lip may be taped to help reduce the width of the cleft.

Since ear infections are more common in children with cleft palate, we recommend a hearing test to determine whether ventilating tubes, which reduce the risk of ear infections, should be placed in the ears at the time of the palate surgery. In addition, an eye examination is usually recommended because eye anomalies are sometimes found in children with cleft lip and palate.

The lip cleft is usually repaired when the infant is around 10 weeks old or weighs 10 pounds. This surgery takes two to three hours and the child usually stays in the hospital for one night.

The cleft palate is generally repaired when the baby is around 10 months old or starting to make sounds of speech. Palate surgery usually takes two to three hours, with the infant staying in the hospital one or two nights. Although speech is generally normal after cleft palate repair, some children may need speech therapy and possibly a second palate surgery.

Most children also need orthodontic treatment with braces and alveolar bone grafting to fill the remaining gap in the gum line. The first phase of treatment is usually to widen the upper jaw with an orthodontic appliance when the permanent first molars and front teeth have come in, at around 7 years of age. Bone grafting surgery is done after the widening is complete.

A child with a cleft lip and palate may encounter social and emotional challenges unique to this condition. Support organizations and resources are available for children with clefts and their families.

Because this birth defect may have a genetic link, families may be referred to the Medical Genetics and Genomics Clinic for counseling.