Cleft Lip and Cleft Palate

Overview

What is cleft lip and cleft palate?

The major symptom is the presence of the cleft at birth. A cleft lip could be as small as a tiny notch in the upper lip. It could also be as large as a split or hole that goes up into the nose. A cleft palate could be just a small area that isn’t formed properly. But it also could be a large separation in the roof of the mouth.

Children who have clefts often have other health issues. They can have trouble eating and talking. They may also have hearing problems, problems with their ears, or problems with their teeth.

Symptoms

The major symptom is the presence of the cleft at birth. A cleft lip could be as small as a tiny notch in the upper lip. It could also be as large as a split or hole that goes up into the nose. A cleft palate could be just a small area that isn’t formed properly. But it also could be a large separation in the roof of the mouth.

Children who have clefts often have other health issues. They can have trouble eating and talking. They may also have hearing problems, problems with their ears, or problems with their teeth.

Causes

What causes cleft lip and cleft palate?

Cleft lip and cleft palate are defects that occur early in pregnancy. A baby’s facial features develop in the first trimester (3 months). The lips form first, followed by the mouth and palate. Clefts occur if the tissues and cells don’t form right. Cleft lip and cleft palate can occur by themselves. They also can be part of another condition or syndrome.

No one knows exactly what causes clefts. Doctors believe it’s due to factors from genetics or the environment. There are certain things that could increase your risk of having a baby with a cleft. These include:

  • Having a family history of cleft lip or palate.
  • Using tobacco, drugs, or alcohol during pregnancy.
  • Not getting enough nutrients during pregnancy, such as folic acid.
  • Having diabetes before pregnancy.
  • Taking certain medicines, such as some for epilepsy, during pregnancy.
  • Being obese during pregnancy.
  • Having certain infections during pregnancy, such as rubella (German measles).

Diagnosis

How is cleft lip and cleft palate diagnosed?

Cleft lip and cleft palate are usually diagnosed at birth during the baby’s first examination. Sometimes your doctor can see it on a routine ultrasound. This is an imaging test done throughout your pregnancy.

Prevention

Can cleft lip and cleft palate be prevented or avoided?

The exact cause of these birth defects is unknown. So, you cannot prevent or avoid them. But there are steps you can take to lower your risk of having a baby with a birth defect. These include:

  • Taking folic acid before and during pregnancy.
  • Avoiding tobacco, drugs, and alcohol during pregnancy.
  • Getting to a healthy weight before pregnancy and not gaining too much weight during pregnancy.
  • Getting vaccinations and protecting yourself from infections.

Talk to your doctor about these and other ways to help reduce the chance of birth defects.

Treatment

Cleft lip and cleft palate treatment

The treatment for cleft lip and cleft palate depends on a few key factors. These include the type of cleft and your baby’s overall health. Clefts can cause problems with a child’s development. So, treatment is recommended to start as early as possible.

Most babies who have a cleft lip, cleft palate, or both will need some type of surgery. Surgery to repair a cleft lip is usually done before the baby is 1 year old. A cleft palate is usually repaired before the baby is 18 months old. Some children will need more surgeries as they grow.

Clefts can create other health issues, such as speech and dental problems. You should work with your doctor to form a team of experts to treat your baby. The group will contain doctors and nurses from many related areas. It could include an oral surgeon, speech therapist, pediatric dentist, audiologist, and nutritionist, among many others. You also can search for special cleft teams and centers throughout the United States.

Several groups can help you pay for these expenses. These include the Cleft Palate Foundation (CPF), Cleft Advocate, and FACES: The National Craniofacial Association.

Living with cleft lip or cleft palate

Over time, most children need added treatment to manage their related issues. This is another reason to have a cleft team that you know well and are happy with. Some follow-up problems include:

  • Ear tubes, for hearing loss or fluid buildup.
  • Dental care, for any teeth or mouth issues.
  • Speech therapy, for language difficulties.
  • General counseling, for emotional well being. Doctors also recommend counseling for parents and other family members. The condition affects everyone. It is important to talk with doctors on how to best manage it.

Adults who had cleft lip or cleft palate as a child may have some lasting effects. But with early treatment, most live normal and healthy lives. You do have a chance of passing the birth defect to your children. This is a low percentage though, as most cleft cases are random. You can get genetic testing to learn more about this.

Questions to ask your doctor

  • Will my child always have issues related to their cleft lip or cleft palate?
  • If I have cleft lip or cleft palate, what is the chance of my children having it?
  • If one child has it, what is the chance of future children having it?