Cleft lip and cleft palate

Cleft lip and cleft palate are openings or splits in the upper lip, the roof of the mouth (palate) or both. Cleft lip and cleft palate result when facial structures that are developing in an unborn baby don't close completely. Cleft lip and cleft palate are among the most common birth defects. They most commonly occur as isolated birth defects but are also associated with many inherited genetic conditions or syndromes.

Having a baby born with a cleft can be upsetting, but cleft lip and cleft palate can be corrected. In most babies, a series of surgeries can restore normal function and achieve a more normal appearance with minimal scarring. Sometimes the opening in the palate can connect with an opening in the gums and the lip (cleft lip and palate). These orofacial clefts are some of the most common birth defects. Most kids can have surgery to repair them early in life.

A baby with a cleft might have:

• only a cleft palate
• only a cleft lip
• both a cleft lip and a cleft palate

The exact cause(s) of cleft lip and cleft palate are not completely understood. Some evidence suggests the conditions may be genetic. Additional research suggests a combination of genetic and environmental factors affecting the mother during pregnancy — including smoking, diabetes or the use of certain medications — could be connected. Genetic consultation may be suggested.

However, some cleft lip and palate cases may not be related to genetic or environmental factors. The cause of those cases is still unknown and often, the conditions cannot be prevented.

Beyond the cosmetic abnormality, other possible complications that may be associated with cleft lip and cleft palate include:

• Feeding difficulties. Feeding difficulties occur more with cleft palate abnormalities. The infant may be unable to suck properly because the roof of the mouth is not fully formed.
• Ear infections and hearing loss. Ear infections are often due to a dysfunction of the tube that connects the middle ear and the throat. Recurrent infections can then lead to hearing loss.
• Speech and language delay. Due to the opening of the roof of the mouth and the lip, muscle function may be decreased, which can lead to a delay in speech or abnormal speech. Ask your doctor if consultation with a speech therapist would be right for your child.
• Dental problems. As a result of the abnormalities, teeth may not develop normally and orthodontic treatment may be required.

For most infants with cleft lip alone, your child’s surgeon can repair the abnormality within the first several months of life. To repair a cleft lip, the plastic surgeon uses a special technique to suture the two sides of the lip together, leaving a scar that blends into the lip. The goal of this surgery is to fix the separation of the lip. Sometimes, a second operation is needed.

Cleft palate repairs are usually done between the ages of 6 to 18 months. This is a more complicated surgery, and it is done when the baby is bigger and better able to tolerate the surgery. Your child’s doctor will advise about the exact timing of the surgery. To repair a cleft palate, the plastic surgeon uses tissue from either side of the mouth to fill in the gap. A second operation may be required.

At your first visit with the plastic surgeon, he or she will explain the details of the surgery, risks, complications, costs, recovery time and outcomes.

If your child has a cleft lip and/or palate, your pediatrician will talk to you about a cleft lip and palate treatment team. This team of health care professionals will work together to meet your family's needs and, ultimately, help your child transition to adult care.

Besides the pediatrician, your child's treatment team may include:

• plastic surgeon
• ear, nose, and throat physician (otolaryngologist)
• oral surgeon
• orthodontist
• dentist
• speech-language pathologist
• audiologist
• nurse
• social worker
• psychologist or therapist
• geneticist
• team coordinator

Your child might visit this care team a few times a year, depending on his or her needs. Who is seen during a visit depends on the care team's structure and your child's needs. The team coordinator will help organize the visits, and the team should communicate with your doctor about the treatment plan.

Maintaining healthy teeth and preventing cavities is very important for kids with cleft lip and palate, who can have more dental problems than other kids. They should see a dentist regularly and brush and floss every day.

Kids with cleft lip and palate may begin orthodontic treatment as early as 6 years of age. It may start with palatal expansion, a process that makes the width of the palate normal. Later, it may involve braces to position the teeth. Your orthodontist will discuss these issues with you.

Some kids with a cleft might be missing a permanent tooth, which can be replaced with a removable appliance or, in early adulthood, a dental implant.

Some kids will need speech therapy after a repair is done. The speech-language pathologist will closely monitor your child's progress and talk with you about whether therapy is needed.

Your child’s doctor may allow breast-feeding, bottle feedings or cup feedings after surgery. Your child should be placed on a soft diet for seven to 10 days after surgery. For older infants and children, age-appropriate soft foods may include strained baby foods, popsicles, yogurt, mashed potatoes and gelatin.

Your child should not use a straw or pacifier, as both could damage the surgical repair.

Your child can walk or play calmly after surgery. He or she should not run or engage in rough play (i.e., wrestling or climbing) or play with “mouth toys” for one to two weeks after surgery. Your child’s doctor will advise you when your child can safely return to regular play.

Following up with your child’s surgeon and the cleft team is very important. Your child’s doctor will also be an important part of your child’s overall health management after the surgery.