Oral clefting occurs when the tissues of the lip and/or palate of a fetus don’t grow together early in pregnancy. Children with clefts often don’t have enough tissue in their mouths, and the tissue they do have isn’t fused together properly to form the roof of their mouths.

Problems with genes passed down from one or both parents, drugs, viruses, or other toxins can all cause such birth defects. Cleft lip and palate may occur along with other syndromes or birth defects in which the tissues of the mouth or lip don’t form properly during fetal development.

A cleft lip and palate can affect the appearance of one’s face, and may lead to problems with feeding and speech, as well as ear infections. Problems may range from a small notch in the lip to a complete groove that runs into the roof of the mouth and nose. These features may occur separately or together.

A cleft lip appears as a narrow opening or gap in the skin of the upper lip that extends all the way to the base of the nose. A cleft palate is an opening between the roof of the mouth and the nasal cavity. Some children have clefts that extend through both the front and rear part of the palates, while others have only partial clefting.

There are generally three different kinds of clefts:

  • cleft lip without a cleft palate
  • cleft palate without a cleft lip
  • cleft lip and cleft palate together

In addition, clefts can occur on one side of the mouth (unilateral clefting) or on both sides of the mouth (bilateral clefting).

More boys than girls have a cleft lip, while more girls have cleft palate without a cleft lip.

Because clefting causes specific visible symptoms, it’s easy to diagnose. It can be detected through a prenatal ultrasound. If the clefting has not been detected prior to the baby’s birth, it’s identified immediately afterward.

Signs and Symptoms

A cleft lip and palate is noted at birth by the presence of a gap or cleft in the upper lip either on one or both sides of the lip together with a cleft in the palate (the roof of the mouth). A cleft palate can either be open and obvious or be covered over by the lining or mucous membrane of the roof of the mouth, called a sub mucous cleft, which is not visible to the naked eye.

An infant with cleft lip and palate usually needs to be bottle-fed (either breast milk or formula) using special nipples.

Treatment

Surgery is necessary to repair a cleft lip and palate, and this intervention is considered reconstructive and not cosmetic.

Treatment of a cleft lip and palate occurs in stages determined by the child’s growth and development. Soon after birth and in preparation for surgery, the lip may need to be taped to help reduce the width of the cleft.

Since ear infections are more common for a child with a cleft palate, a hearing test is recommended to determine whether ventilating tubes, which reduce the risk of ear infections, should be placed in the ears at the time of palate surgery. In addition, an eye examination usually is recommended because associated eye anomalies are not uncommon.

The lip cleft usually is repaired when the infant is around 10 weeks old (or at 10 pounds). Surgery takes two to three hours and often requires the infant to remain in the hospital one night. If needed, a revision of the lip repair will occur before the child begins school.

The cleft palate tends to be repaired when the infant is around 8 to 10 months old or when he or she is starting to make sounds of speech. Palate surgery often takes about two or three hours, with the infant staying in the hospital one or two nights. Although a child’s speech usually is normal after cleft palate repair, in some cases, speech therapy or a second palate surgery may be needed. A submucous cleft palate is only repaired surgically if it is determined that the procedure would improve speech difficulties.

Orthodontic treatment (braces) and alveolar bone grafting to fill the remaining gap in the gum line often are necessary. The first phase of treatment usually includes the widening of the upper jaw with an orthodontic appliance and occurs once the permanent front teeth have come in, when the child is around 7 years old. Bone grafting surgery is done after the widening is completed. Orthodontic treatment continues until all teeth are aligned.

A child with a cleft lip and palate may encounter social and emotional challenges unique to this condition.

Cleft Lip Surgery

A cleft lip can range in severity from a slight notch in the red part of the upper lip to a complete separation of the lip extending into the nose. Clefts can occur on one or both sides of the upper lip. Surgery is generally done when the child is about 10 weeks old.

To repair a cleft lip, the surgeon will make an incision on either side of the cleft from the mouth into the nostril. He or she will then turn the dark pink outer portion of the cleft down and pull the muscle and the skin of the lip together to close the separation. Muscle function and the normal “cupid’s bow” shape of the mouth are restored. The nostril deformity often associated with cleft lip may also be improved at the time of lip repair or in a later surgery.

Cleft Palate Surgery

In some children, a cleft palate may involve only a tiny portion at the back of the roof of the mouth; for others, it can mean a complete separation that extends from front to back. Just as in cleft lip, cleft palate may appear on one or both sides of the upper mouth. However, repairing a cleft palate involves more extensive surgery and is usually done when the child is nine to 18 months old, so the baby is bigger and better able to tolerate surgery.

To repair a cleft palate, the surgeon will make an incision on both sides of the separation, moving tissue from each side of the cleft to the center or mid line of the roof of the mouth. This rebuilds the palate, joining muscle together and providing enough length in the palate so the child can eat and learn to speak properly.

Sources: UCS Fhealth , Kids Health, Plastic Surgery

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