Cleft Lip and Cleft Palate

Cleft lip and palate affect feeding, speech, and appearance. Early diagnosis and surgery restore function and confidence. Learn about causes, treatments, and how to ensure the best care for your child.

What is Cleft Lip?

A cleft lip is a congenital condition where the upper lip does not form properly during fetal development. This results in an opening or gap in the lip, which can vary in size. It may be a small notch or extend through the lip and into the nose.

Cleft lip can occur on one side (unilateral) or both sides (bilateral) of the mouth. It happens when the tissues that form the lip fail to fuse completely during early pregnancy. This condition can occur alone or with a cleft palate.

What is Cleft Palate?

A cleft palate is a birth defect where the roof of the mouth (palate) does not fully close during fetal development. This creates an opening that can extend from the front of the mouth to the throat.

Cleft palate can occur alone or with a cleft lip. It may affect only the soft palate (back part of the mouth) or both the soft and hard palate (front part). This condition can lead to difficulties with feeding, speech, and ear infections.

Symptoms Cleft Lip and Palate

Cleft lip and cleft palate are visible at birth. However, they can also cause other functional issues. Symptoms vary depending on the severity of the condition.

Cleft Lip Symptoms:

●       A visible opening or gap in the upper lip

●       A notch or split on one or both sides of the lip

●       Difficulty with sucking and feeding

Cleft Palate Symptoms:

●       An opening in the roof of the mouth

●       Feeding difficulties, with milk sometimes leaking from the nose

●       Speech difficulties or nasal-sounding speech

●       Frequent ear infections due to fluid buildup in the middle ear

What Causes Cleft Lip and Palate?

Cleft lip and cleft palate occur when tissues in the baby’s face and mouth do not fuse properly during early pregnancy. The exact cause is not always known, but several factors can increase the risk.

Genetic Factors and Family History of Cleft Lip

●       Family history of cleft lip or palate

●       Inherited genetic mutations

Environmental Influences During Pregnancy

●       Smoking or alcohol use during pregnancy

●       Poor maternal nutrition, especially lack of folic acid

●       Certain medications taken during pregnancy (e.g., some anti-seizure or acne drugs)

●       Exposure to harmful chemicals or infections during pregnancy

A combination of genetic and environmental factors often contributes to the condition.

Exploring Other Causes of Cleft Lip or Palate

While genetics and environmental factors play a major role, other possible causes are still being studied. Some cases occur without a clear reason.

Other Potential Causes:

●       Medical Conditions: Some syndromes, such as Pierre Robin sequence or Van der Woude syndrome, are linked to cleft lip and palate.

●       Maternal Health Issues: Uncontrolled diabetes or obesity during pregnancy may increase the risk.

●       Oxygen and Blood Flow Issues: Poor circulation or reduced oxygen supply to the fetus may affect tissue development.

Ongoing research continues to explore how different factors contribute to cleft formation.

What Are the Types of Cleft Lip and Palate?

Cleft lip and cleft palate can vary in severity and appearance. They may occur separately or together.

Unilateral Cleft Lip

This occurs when there is a gap on only one side of the upper lip. The severity can range from a small notch to a large opening that extends into the nose.

Bilateral Cleft Lip

A bilateral cleft lip affects both sides of the upper lip. In severe cases, the central portion of the lip may appear separate from the rest of the face. This type is often associated with a cleft palate.

Complete Cleft Lip

A complete cleft lip means the split extends from the lip through the upper gum and reaches the base of the nose. It can impact feeding and speech development.

Incomplete Cleft Lip

An incomplete cleft lip appears as a minor notch or partial split in the upper lip. It does not extend to the nose and is usually less severe than a complete cleft lip.

Incomplete Cleft Palate

This type affects only the soft palate, which is the back part of the roof of the mouth. It may not always be visible at birth but can cause speech and feeding difficulties.

Complete Cleft Palate

A complete cleft palate occurs when both the soft and hard palate fail to close, leaving a significant gap. This can make eating, speaking, and breathing more challenging.

Submucous Cleft Palate

In this condition, the surface tissue of the palate appears intact, but the underlying muscles and bone are not fully developed. It may go undetected at birth but can lead to speech and feeding difficulties later.

How is Cleft Lip and Cleft Palate Diagnosed?

Cleft lip and cleft palate are usually diagnosed before or at birth. The diagnosis process involves prenatal screening and physical examination after delivery.

Prenatal Diagnosis

An ultrasound during pregnancy can detect a cleft lip as early as the second trimester, usually around 18 to 22 weeks. However, a cleft palate is harder to detect on ultrasound because it is inside the mouth. If suspected, a doctor may recommend additional imaging or genetic testing to check for other conditions.

Postnatal Diagnosis

At birth, a cleft lip and cleft palate are identified through a physical examination. A doctor will check the baby’s mouth, nose, and palate to assess the severity of the condition. If a submucous cleft palate is suspected, further tests like nasal endoscopy or speech evaluation may be needed as the child grows.

Treatment for Cleft Lip and Palate

Cleft lip and cleft palate are treatable conditions. Treatment often involves surgery and additional therapies to improve appearance, speech, and overall function. A team of specialists, including plastic surgeons, speech therapists, and orthodontists, works together to provide comprehensive care.

Surgical Treatment

Cleft Lip Repair

Cleft lip surgery is usually performed when the baby is around 3 to 6 months old. The procedure, called cheiloplasty, involves closing the gap in the upper lip by repositioning and stitching the tissues. This helps restore the normal shape of the lip and nose. In some cases, additional surgeries may be needed as the child grows.

Cleft Palate Repair

Cleft palate surgery, or palatoplasty, is typically done when the baby is between 9 and 18 months old. The goal is to close the opening in the roof of the mouth and reconnect muscles to improve speech and feeding. This surgery reduces the risk of speech problems and ear infections.

Additional Surgeries

●       Secondary lip or nose surgery may be needed to refine the appearance of the face as the child grows.

●       Bone grafting is often done between 8 and 12 years old to fill gaps in the upper jaw and support permanent teeth.

●       Orthognathic surgery may be required in the teenage years to correct jaw alignment.

Speech Therapy

Some children with cleft palate may have difficulty with speech development. A speech therapist helps improve pronunciation and communication skills. Therapy may continue for several years, depending on the severity of the condition.

Dental and Orthodontic Care

Children with cleft lip and palate often have dental issues, including misaligned teeth or missing teeth. Orthodontic treatment, such as braces, helps correct these problems. A prosthodontist may also create dental appliances to improve function and appearance.

Ear and Hearing Care

Children with cleft palate are at higher risk for ear infections and hearing loss due to fluid buildup in the middle ear. Regular hearing tests and the use of ear tubes (if necessary) help prevent complications.

Psychological and Emotional Support

Children with cleft lip and palate may experience self-esteem or social challenges. Counseling and support groups can help them and their families cope with emotional concerns and improve confidence.

Early intervention and a multidisciplinary approach ensure the best possible outcome for children with cleft lip and palate.

How Can the Challenges of Raising a Child with Cleft Lip be Managed?

Raising a child with cleft lip and palate comes with challenges, but with proper medical care, support, and early intervention, children can lead healthy lives. Managing these challenges requires a combination of medical treatment, emotional support, and practical strategies.

Feeding Difficulties

Babies with cleft lip and palate may have trouble sucking and swallowing. Special bottles and nipples, such as Haberman feeders or squeeze bottles, help ensure proper nutrition. A feeding specialist or lactation consultant can provide guidance.

Speech Development

Children with cleft palate may develop speech delays or nasal-sounding speech. Early speech therapy helps improve communication skills. Parents can support speech development by encouraging clear pronunciation and engaging in speech exercises at home.

Dental and Orthodontic Care

Children with cleft conditions may have misaligned teeth or missing teeth. Regular visits to a pediatric dentist and orthodontist help maintain oral health. Early orthodontic treatment may be needed to align teeth properly.

Ear Infections and Hearing Loss

Cleft palate can affect middle ear function, leading to fluid buildup and frequent ear infections. Regular hearing tests and ear tube placement (if needed) can prevent hearing loss and speech delays.

Social and Emotional Well-being

Children with cleft lip and palate may face self-esteem challenges due to their appearance or speech difficulties. Parents can provide emotional support by encouraging confidence, addressing bullying concerns, and seeking counseling or support groups if needed.

Coordinated Medical Care

A multidisciplinary team, including surgeons, speech therapists, audiologists, and dentists, ensures comprehensive care. Regular follow-ups help track progress and address any issues early.

With early intervention, medical advancements, and a strong support system, children with cleft lip and palate can thrive and lead fulfilling lives.

Can Cleft Lip and Palate Be Prevented?

Cleft lip and cleft palate cannot always be prevented, but certain steps may help reduce the risk. Since these conditions result from a combination of genetic and environmental factors, taking preventive measures during pregnancy can support healthy fetal development.

Prenatal Care and Healthy Lifestyle

●       Take Folic Acid: A daily prenatal vitamin with at least 400 mcg of folic acid helps reduce the risk of birth defects, including cleft lip and palate.

●       Avoid Smoking and Alcohol: Tobacco and alcohol use during pregnancy increase the risk of cleft conditions.

●       Maintain a Balanced Diet: Proper nutrition, including vitamins and minerals like B vitamins, supports fetal growth.

●       Manage Chronic Conditions: Conditions like diabetes or obesity should be well-controlled before and during pregnancy.

Medication Safety

●       Some medications, such as anti-seizure drugs and acne treatments (e.g., isotretinoin), may increase the risk of cleft lip and palate. Always consult a doctor before taking any medication during pregnancy.

Genetic Counseling

●       If there is a family history of cleft lip or palate, genetic counseling can help assess the risk and provide guidance for future pregnancies.

While not all cases can be prevented, following these steps can help lower the chances of cleft lip and palate development.

Complications of Surgery to Repair Cleft Lip or Cleft Palate

Surgery for cleft lip and cleft palate is generally safe and effective. However, as with any surgical procedure, there are potential risks and complications. These may vary depending on the child's health, the severity of the cleft, and the skill of the surgical team.

Possible Complications:

●       Infection – Wound infections may occur, but antibiotics help prevent serious issues.

●       Bleeding – Minor bleeding is normal, but excessive bleeding is rare.

●       Scarring – Some scarring is expected, but additional surgery may improve the appearance.

●       Poor Wound Healing – In some cases, the repaired tissue may not heal properly, requiring revision surgery.

●       Speech Problems – Some children may continue to have nasal-sounding speech and require additional surgery or speech therapy.

●       Hearing Issues – Ear infections can still occur, requiring regular monitoring.

●       Dental Problems – Misaligned teeth or missing teeth may need orthodontic treatment.

●       Breathing Difficulties – Rarely, changes in the airway after surgery can cause breathing issues.

Most complications are manageable with proper medical care and follow-up. Regular checkups help monitor healing and address any concerns early.

Frequently Asked Questions

What is the difference between a cleft palate and a cleft lip?

A cleft lip is a gap in the upper lip that may extend to the nose. A cleft palate is an opening in the roof of the mouth that affects speech and feeding. A child can have one or both conditions. Both happen when facial structures do not fully develop during pregnancy.

Can you have both cleft lip and palate?

Yes, a newborn can have both cleft lip and cleft palate. This means there is a gap in the upper lip and an opening in the roof of the mouth. The severity varies. Some babies have only one condition, while others have both. Early treatment, including surgery, helps improve feeding, speech, and appearance.

Can a cleft palate be cured?

Yes, cleft palate can be treated with surgery. The procedure closes the gap in the roof of the mouth, improving speech and feeding. Most children need additional care, such as speech therapy and dental treatment. Early intervention helps achieve the best results. Regular follow-ups ensure proper healing and development.

Is cleft lip a disability?

Cleft lip is a birth condition, but it is not always considered a disability. Surgery and therapy help most children lead normal lives. However, severe cases may cause speech, feeding, or dental issues that require ongoing care. In some situations, it may qualify as a disability if it significantly affects daily functioning.

At what age is a cleft palate repaired?

Doctors usually repair a cleft palate when the baby is 9 to 18 months old. Surgery closes the gap in the roof of the mouth and improves speech and feeding. Early repair helps with normal development. Some children may need additional surgeries later to improve speech or correct dental and jaw issues.

How painful is cleft palate repair?

Cleft palate repair causes some pain, but doctors manage it with medication. Babies may feel discomfort, especially when eating. Pain usually decreases within a few days. Most children recover well within one to two weeks. Follow-up care, including soft foods and proper wound care, helps ensure healing and reduces discomfort.