Cleft Palate and Cleft Lip

During normal fetal development, the structures of the two sides of the head and face come together and fuse in the middle. When this happens, the typical facial feature of lips and a normal mouth are formed. However, if these two sides of the head don’t join properly, it can result in a cleft palate and/or cleft lip. A “cleft” refers to a split or opening. Cleft palate and clef lip are congenital deformities, meaning the condition is present at birth.

The Difference Between Cleft Palate and Cleft Lip

The palate is the roof of the mouth; it develops between weeks 6 and 9 of pregnancy. It is possible for a child to have a cleft palate and normally developed lips, or a cleft lip with a normally formed palate, or to have a cleft extending through both the palate and lips (this accounts for around half of all clefts).

A cleft lip and palate are more common in boys and among Asian ethnicities. It is less common in African Americans. Conversely, an isolated cleft palate (with normally formed lips), is more common in girl babies with no ethnic bias.

The cleft may be unilateral – on one side of the mouth, or it can be bilateral – there is a split on both sides. It is uncommon for a cleft to be perfectly in the middle of the lip or palate.

What Causes Cleft Palate/Lips?

The exact cause of clefts isn’t fully understood, but it’s believed to be a combination of genetic defects and factors affecting the pregnancy. Current research has demonstrated that factors that can increase the chance of a baby with a cleft lip or palate can include:

• The mother smoking, consuming alcohol, or being exposed to recreational drugs during pregnancy
• The mother having diabetes
• The mother using certain anti-epilepsy medications during the first trimester of pregnancy

A cleft lip or palate is also known to be part of over 400 different syndromes, including Down syndrome.

Complications of Clefts

The severity of a cleft can be variable from infant to infant. A cleft lip may just be a little divot in the upper lip or the split may involve the entire lip up to the nose.

Minor cases, such as just a small notch in the lip, cause few functional problems other than possibly being a cosmetic concern as the child grows older. However, more severe malformations can have implications for:

• Eating and drinking
• Breathing
• Speaking
• Ear infections
• Hearing problems
• Dental problems

Treatment for Cleft Palate and Cleft Lip

Managing a child with a cleft palate and/or lip will often involve a number of different healthcare professionals, including an ENT (ear, nose, throat) doctor specialized in facial reconstruction, plastic surgeon, speech pathologist, pediatric dentist, orthodontist, audiologist, pediatrician, and psychologist. A geneticist may also be involved if the parents need genetic counseling around the risk of having another child with a cleft or to advise on whether the cleft is associated with a genetic syndrome.

The recommended treatment for clefts is tailored to the severity and location of the split, the needs of the child and the family, and whether there are other birth defects or syndromes present. To repair a cleft palate, surgery is recommended between 9 and 18 months of age, while surgery for a cleft lip repair is usually offered when the baby is between 10 and 12 weeks old. Most cases will need a few surgeries to achieve the best results, both functionally and cosmetically.

Other interventions can help with the complications of a cleft lip or palate. If breathing is a problem, oral appliances may be recommended. As fluid build-up in the ear and subsequent repeated infections are common, an ENT doctor may recommend inserting ear tubes to avoid hearing damage.

Input from other specialists can also help the child to develop in other areas as normally as possible, such as a speech therapist to support language development or a nutritionist to assist during feeding difficulties. As the child enters school, research shows that clefts tend to be associated with lower academic achievement, behavioral inhibition, and low self-esteem due to appearance. Counseling with a psychologist can be useful in these instances.

Overall, children with cleft lip or palate are able to live a relatively normal life after successful treatment.