Cleft palate

Overview

A cleft palate is a birth defect that results when the roof of the mouth, called the palate, fails to form completely during early fetal development. This causes a gap, called a cleft, in the palate. A cleft palate may occur alone or together with a cleft lip. It's also possible for children to have a cleft lip only and a normal palate.

Clefts of the lip and palate are the most common birth defect affecting the face, found in about one out of every 600 newborns. 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 chance 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 either parent did anything wrong during the pregnancy.

Babies with a cleft palate usually must be bottle fed, with breast milk or formula, using special nipples. Surgery to repair the cleft is performed at about 10 months of age or when the child begins to make sounds of speech. Most children will also need orthodontic treatment with braces during early adolescence.

Signs & symptoms

A cleft palate can either be an open and obvious gap in the roof of the mouth, or a cleft that's covered over by the lining or mucous membrane of the palate. The latter, known as a submucous cleft, isn't visible to the naked eye.

A submucous cleft is characterized by a wide or split uvula (the small, bell-shaped tissue that hangs down at the end of the palate), a small cleft or notch at the end of the hard palate and a thinning of the muscles in the palate that's covered by mucous membrane.

Diagnosis

Unlike a cleft lip, a cleft palate is usually not detectable in the womb with prenatal ultrasound. It may be diagnosed by physical examination at birth.

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

Treatment

Children with a cleft palate are unable to suck properly, which makes breastfeeding very difficult or impossible. They usually need to be bottle fed, with either 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 to bring your baby to the pediatrician for weekly weight checks to make sure he or she is gaining enough weight.

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

The surgery is generally performed when the baby is around 10 months old or starting to make sounds of speech. The procedure usually takes two to three hours, with the baby staying in the hospital one to two nights. Although speech is usually normal after cleft palate repair, some children need speech therapy and possibly a second palate surgery. Most children will need orthodontic treatment with braces in early adolescence.

A child with a cleft 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.