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Cleft lip and palate occurs in about one in 1,000 births and is one of the most common conditions we see in our office. Clefts occur when parts of the face don’t join together as they should, which causes an abnormal separation of the lip and/or the palate (roof of the mouth). A baby’s lip typically forms by 6 to 8 weeks gestation. His palate forms a little later, generally by 9 weeks gestation. Because they form at different times, it’s possible to have a cleft only of the lip, only of the palate, or of both. Clefts may be partial or complete and may involve only one side of the mouth or both sides.
Although up to one-third of clefts occur where there is a family history of clefts, the majority of cases occur sporadically. Clefts have been associated with a variety of drugs, including alcohol, cigarettes, vitamin A derivatives and some seizure medications. However, none of these medications has been shown to cause clefts. A number of genes has been identified which may make a cleft slightly more likely to occur. No single gene causes clefts. In fact, a number of genetic and environmental factors must occur simultaneously in order for clefts to occur.
Since clefts of the lip and palate occur during the first 10 weeks of gestation, it’s possible that a cleft may be diagnosed by prenatal ultrasound. When a diagnosis of clefting is made before the baby is born, we recommend that families meet with a member of our team to help them learn what to expect and prepare for the care of their new baby. If the cleft isn’t seen by prenatal ultrasound, the diagnosis is typically made at the time of birth.
Because babies with clefts of the lip and palate are missing some of the normal structures of the lip and mouth, they may have difficulty with feeding. Babies with clefts may have difficulty sucking and need specialized bottles or nipples to be sure they are able to get all of the nutrients they require. As babies grow, they may also have difficulties with speech. Given these potential problems, it is important that babies with clefts be evaluated early following birth so parents can receive the education and support they’ll need to help their baby thrive.
Children with clefts may require a number of surgical procedures throughout childhood and adolescence, depending on the type and extent of the cleft. No uniform treatment plan may be applied to all children. Just as each child is unique, the treatment plan for each child with a cleft is tailored to that child's individual needs.