Understanding Cleft Lip And Cleft Palate 

by Audrey Madigan

Each year approximately 4,200 babies in the United States are born with cleft lip or cleft palate.  Oral clefts are the fourth most common birth defect in the U.S. and are more common in children of Latino, Asian or Native American origins. Clefts develop very early in a woman’s pregnancy and result when there is not enough tissue in a baby’s mouth and lip area to join properly.  Ultrasound can often detect a cleft in an unborn baby. This allows the family to meet with a member of the cleft palate team before birth, receive educational materials, and begin a treatment plan.

What is cleft lip and cleft palate?  A cleft lip is a split in the upper lip that can be as small as a notch on the edge of the lip or as large as an opening that goes through the lip into the nose.  This split can occur on one or both sides of a child’s mouth.  With a cleft palate, a child’s mouth doesn’t form completely leaving an opening in the back soft tissue or the front bony part of the roof of the mouth.  A cleft palate can result on one or both sides of a child’s palate.  Since the lips and the palate develop separately (lips at about 6 weeks during pregnancy and palate at approximately 10 weeks), a child can have just a cleft lip, a cleft palate or both.

The cause of cleft lip and cleft palate isn’t entirely known.  However, some possibilities are:

• Being genetically predisposed – a child has a greater chance of developing clefts if a sibling, parent or relative has had the problem.
• Deficiency of certain vitamins in pregnancy, such as folate, can increase the risk.
• Resulting from another medical condition a child may have.

Cleft lip and cleft palate can be connected to other problems such as:

• Trouble feeding – a baby with a cleft palate can have difficulty sucking and with food and liquid entering their nose.
• Middle ear fluid buildup and hearing loss – kids with cleft palate usually require small pressure equalization tubes placed in their eardrums to drain fluid and increase hearing.
• Dental abnormalities – a child can have missing, small, extra and malpositioned teeth as well as problems with gums and the bone that supports the teeth.
• Speech difficulties – children with cleft lip have fewer problems than those with cleft palate.  The most common is hypernasality, a condition that causes a child’s speech to sound as if he is talking through his nose.

There is good news for parents and children born with cleft lip and cleft palate – the condition can be treated.  In most cases, clefts can be repaired with surgery.  With cleft lip, surgery is usually done at 10 to 12 weeks of age.  With cleft palate, surgery is usually done between 6 to 9 months of age.

Surgery can close the lip and the palate and restore form and function.  Affected patients often require a few specialized surgeries and therapies during childhood into the teen years. They can also require plastic surgery, dental and orthodontic care, speech therapy, treatment for ear, nose and hearing problems and emotional and psychological support. As a result, a team of professionals from many different specialties is usually needed to provide care at different stages of a child’s development.

Members of a treatment team could include:

Pediatrician

Plastic surgeon

Ear, nose and throat doctor

Dentist

Oral surgeon

Orthodontist

Audiologist

Speech or language specialist

Genetic counselor

Social worker

Team coordinator

Nutritionist

At Children’s Hospital, R. Mark Ray, M.D., an ear, nose and throat specialist and reconstructive surgeon can even begin treating a child with an oral cleft before they take their first breath. Dr. Ray meets with parents whose baby has been diagnosed with a cleft to inform and reassure them about their child’s condition and treatment. Ray also works with parents adopting out-of-country children who may have an oral cleft.

The comprehensive team Ray has developed at Children’s Hospital treats children with efficiency and compassion.  Ray says, “A cleft lip or pallet is no longer a roadblock, it’s merely a speed bump that, with proper treatment, can be overcome.”