Cleft Lip and Palate

Condition

What is Cleft Lip and Palate?

Cleft lip and cleft palate is a common birth defect, occurring in approximately 1 in 1,000 births. Clefts occur when parts of the face don’t join together as they should, causing an abnormal separation of the lip and/or the palate (roof of the mouth). Baby’s lips typically form by 6 to 8 weeks gestation. The 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.

Cleft Lip and Palate: Causes

Although up to one-third of clefts occur where there is a family history of clefts, the majority of cleft lip and cleft palate cases are not hereditary. Researchers believe that most cases of cleft lip and cleft palate care caused when several genetic and environmental factors occur at the same time.

Risk Factors

Clefts have been associated with substance abuse during pregnancy, including alcohol, cigarettes, vitamin A derivatives and some seizure medications. Additionally, a family history may increase the risk for a cleft lip or cleft palate. A number of genes have been correlated with higher risks; however, no single gene causes clefts.

Can Cleft Lip and Palate Be Detected in Ultrasound?

Since clefts of the lip and palate occur during the first 10 weeks of pregnancy, it’s possible that a cleft may be diagnosed by prenatal ultrasound. When a diagnosis of clefting is made before the baby is born, your Mercy OB/GYN will connect you with a specialized care team. They’ll help you learn what to expect, prepare for baby’s special care and feeding, and develop a treatment plan. If the cleft isn’t seen by prenatal ultrasound, the diagnosis is typically made at the time of birth.

Cleft Lip and Cleft Palate Symptoms

  • Feeding Difficulties - 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 sucking and need specialized bottles or nipples to be sure they are able to get all the nutrients they need.
    • Feeding evaluation - Since children with clefts frequently have trouble feeding, any newborn with a cleft should be evaluated by a pediatric plastic surgeon and a feeding specialist in the first 1-2 weeks of life. At that time, parents learn strategies to help their baby feed well and thrive.
  • Ear infections & hearing loss - Babies with clefts of the palate are more likely to develop fluid behind their eardrums. If this condition is left untreated, it may progress to ear infections and hearing problems, potentially affecting speech development. For that reason, babies with cleft palate should be seen early by a pediatric ear, nose and throat specialist (ENT) to assess whether they may need ear tubes to help drain the fluid and prevent infection. When ear tubes are needed, they are easily placed at the time of the lip or palate repair. We encourage coordination of surgical procedures to minimize the number of trips to the operating room.
  • Speech & language delay - Children with a cleft palate or cleft lip may have difficulties with speech. Given these potential speech problems, it’s 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.
  • Dental problems - A cleft palate can cause irregularly aligned, misshapen or missing teeth. Children with a cleft palate may also have weak areas in their tooth enamel and problems in their salivary glands, increasing their risk for cavities and gum conditions. The severity of the cleft determines how much dental care is needed. Some children may require extensive oral surgery while others may only need orthodontic treatment.

How are Cleft Lip & Palate Diagnosed?

Most cases of cleft lip and cleft palate are immediately diagnosed at birth and don’t require additional testing. It’s becoming more common to diagnosis this during pregnancy.

It’s possible that a cleft may be diagnosed by prenatal ultrasound since clefts of the lip and palate occur during the first 10 weeks of gestation. When a cleft lip and cleft palate diagnosis is made pre-birth, your Mercy OB/GYN will connect you with a specialized care team. They’ll help you learn what to expect, prepare for special care and feeding and develop a treatment plan.

Cleft Lip and Palate: Management and Treatment

Children with clefts may require several surgical procedures throughout childhood and adolescence, depending on the type and extent of the cleft. A uniform treatment plan cannot 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.  

Cleft Lip and Cleft Palate Surgery

  • Cleft lip repair - Repair of a cleft lip typically occurs at around 3 months of age. The most commonly performed repairs take lip tissue from the sides to close the cleft and lengthen the lip. At the time of lip surgery, some surgeons also choose to surgically reshape the nose which is often uneven due to the cleft.  
  • Cleft palate repair - The palate is usually repaired when the baby is 9 -12 months of age. Most of the commonly performed repairs lead to good results.
  • Lip and nose revision surgery - Revision surgery refers to smaller procedures aimed at fine-tuning symmetry and balance of the nose and lip. The need for this type of surgery is determined by how the child heals from his or her initial surgery and how growth occurs over time. Typically, lip and nose revision surgery (when needed) is first performed when children are preparing to enter school. Additional revision surgery may be performed at later times to address specific concerns.
  • Alveolar bone grafting - For children who have clefts going through the gum line, bone must be placed in the gap to provide a stable platform for the canine tooth to erupt. During this procedure, a small amount of bone is taken from the hip and packed into the gap. This surgery is typically performed when the child is 7 to 9 years of age. A pediatric dentist helps with timing by using X-rays to determine when the canine tooth is forming and preparing to descend.
  • Jaw surgery - For some children with clefts, the upper jaw doesn’t grow properly. This can cause the upper and lower teeth to not meet correctly, with the lower jaw growing far forward of the upper jaw (underbite). Surgical correction may be required. This procedure is usually postponed until the child is nearing completion of his or her facial growth, generally in the mid-teens. Also, a child may need braces to prepare for the procedure.
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