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Cleft Lip and Cleft Palate

baby with cleft lip

​​Cleft lip (cheiloschisis) and cleft palate (palatoschisis) are among the most common birth defects affecting children in North America. Cleft palates and cleft lips occur when the bones of the upper jaw, nose and mouth fuse together to form the roof of the mouth and the upper lip.

A cleft lip is the incomplete formation of the upper lip, while a cleft palate is the incomplete formation of the roof of the mouth. These defects can occur separately or together and can affect one or both sides of the face. They occur very early in development, usually between 6-10 weeks of the pregnan​​​cy.

A cleft lip may look like a small opening on the edge of the lip or can span into the nose and gums. A cleft palate can affect either the soft palate in the back of the throat or can extend and create a hole in the hard palate toward the front of the mouth. Both are typically discovered post-birth.

There are three cleft categories:

  • A cleft lip alone, which is more common in boys.
  • A cleft palate alone, which is more common in girls.
  • Both a cleft lip and a cleft palate, which is more common in boys.

What Causes a Cleft Palate or Cleft Lip?

There is no known cause of the defect. Many clefts are thought to be the result of a combination of genetics and environmental causes. Both parents can pass along the cleft gene to their child(ren).

Potential environmental risks include:

  • A lack of prenatal vitamins, such as folic acid.
  • Taking certain medications, such as anti-seizure medications.
  • Being exposed to certain chemicals during pregnancy.
  • Smoking, drinking or using drugs.

Issues Caused by Cleft Lip and/or Palate

A child with a cleft palate will more likely have feeding problems as a result of the defect. The palate prevents foods and liquids from entering the nose, and a cleft palate causes the child to inhale air and regurgitate food into the nose. A cleft palate also makes it harder to latch on or suck during breast or bottle feeding, so a special nipple or bottle may be needed.

A child with cleft lip and palate may have issues with middle ear fluid buildup and hearing loss as well. Ear fluid cannot pass through the Eustachian tubes as it should, so there may be more infections and potentially hearing loss.

Dental problems are a common side effect of a cleft. A child may have small teeth, extra teeth (supernumerary), missing teeth or teeth that are out of position. There also may be problems with the gums or alveolar ridge (where the sockets for teeth are), which can lead to displacing, tipping or rotation of permanent teeth or no permanent teeth coming in at all.

Speech problems may also develop as a result of a cleft. A child with a cleft lip has fewer issues than a child with a cleft palate. One in five children have speech problems following repair – most children sound hypernasal (speaking through the nose) because the palate doesn't move well enough to prevent air leakage from the nose.

Cleft Lip and Palate Surgery

Cleft repair surgery is a highly individualized procedure. The aim of a cleft lip surgery or cleft palate surgery is to achieve the best possible functionality (how it works) and aesthetic (how it looks) outcome based on your child's unique defect.

The surgery is done under general anesthesia, meaning your child will be asleep throughout the entire procedure. Surgery often takes 1-2 hours, but your child will be in the care of doctors and nurses for 2-4 hours on average.

Cleft Lip Repair Surgery

A child receives cleft lip surgery (cheiloplasty) when he/she is between 3-6 months old. The procedure is done to reconstruct the upper lip to a more normal appearance, which involves closing the connective tissues of the lip. The result is often a small scar between the bottom of the nose and the lip.

If your child has a wide cleft lip or a bilateral cleft lip (cleft down both nostril lines), additional procedures may be needed to help bring parts of the lip closer together before completing the repair. Procedures include:

  • Lip adhesion
  • Molding plate device

Cleft lip surgery will also create a cupid's bow, the curve at the center of the upper lip. If the cleft lip also affects the shape of the nose, additional considerations may be made, such as:

  • Achieving symmetry between nostrils.
  • Creating adequate distance between the nose and upper lip and between the nostrils.
  • Increasing the angle of the nose tip to avoid having a flattened nostril or a downward-pulling nostril.

Cleft Palate Repair Surgery

Cleft palate reconstruction (palatoplasty) is typically performed when your child is 9-12 months old. A plastic surgeon or otolaryngologist (ear, nose and throat doctor) will connect the muscles of the soft palate and rearrange the surrounding tissue in order to close the cleft.

The goal of a cleft palate surgery is to create a palate that allows for normal speech, but some children will sound nasal or develop a nasal sound as they age.

The palate creates the floor of the nasal cavity, so the following considerations are included in the surgery:

  • Allowing for normal growth, function and speech development
  • Position of the palate in relation to the ear canal and hearing abilities
  • Tooth and jaw development as your child ages

Additional Procedures

More surgeries may be needed as your child grows and his/her facial structure changes, such as:

  • Pharyngoplasty, a procedure done to improve speech
  • Alveolar bone graft, which helps provide stability in the jaw for permanent teeth

A bone graft closes gaps in the jaw or gum line around the front teeth and is typically done when your child is 6-10 years old.

As your child reaches the teen years, he/she will likely want to (and should be) more active in decisions about care. He/she may desire additional cosmetic-based procedures to:

  • Make scars less noticeable.
  • Improve the appearance of the nose and upper lip.
  • Improve his/her bite with a corrective jaw procedure (orthognatic surgery).

Along with improving physical appearance, these procedures may also improve:

  • Speech
  • Breathing
  • Overbites/underbites ​