What is cleft lip and cleft palate?
We all start out life with a cleft lip and palate. During normal fetal development between the 6th and 11th week of pregnancy, the clefts in the lip and palate fuse together. In babies born with cleft lip or cleft palate, one or both of these splits failed to fuse.
A “cleft” means a split or separation; the palate is the “roof” of the mouth. A cleft palate or lip then is a split in the oral (mouth) structure. Physicians call clefting a “craniofacial anomaly.” A child can be born with both a cleft lip and cleft palate or a cleft in just one area. Oral clefts are one of the most common birth defects.
Clefts in the lip can range from a tiny notch in the upper lip to a split that extends into the nose. A cleft palate can range from a small malformation that results in minimal problems to a large separation of the palate that interferes with eating, speaking, and even breathing. Clefts are often referred to as unilateral, a split on one side, or bilateral, one split on each side. There are three primary types of clefts:
- Cleft lip/palate refers to the condition when both the palate and lip are cleft. About one in 1,000 babies are born with cleft lip/palate.
- About 50 percent of all clefts
- More common in Asians and certain groups of American Indians
- Occurs less frequently in African Americans
- Up to 13 percent of cases present with other birth defects
- Occurs more often in male children
- Isolated cleft palate is the term used when a cleft occurs only in the palate. About one in 2,000 babies are born with this type of cleft (the incidence of submucous cleft palate, a type of isolated cleft palate, is one in 1,200).
- About 30 percent of all clefts
- All racial groups have similar risk
- Occurs more often in female children
- Isolated cleft lip refers to a cleft in the lip only accounting for 20 percent of all clefts.
What causes clefts?
No one knows exactly what causes clefts, but most believe they are caused by one or more of three main factors: an inherited characteristic (gene) from one or both parents, environment (poor early pregnancy health or exposure to toxins such as alcohol or cocaine), and genetic syndromes. A syndrome is an abnormality in genes on chromosomes that result in malformations or deformities that form a recognizable pattern. Cleft lip/palate is a part of more than 400 syndromes including Waardenburg, Pierre Robin, and Down syndromes. Approximately 30 percent of cleft deformities are associated with a syndrome, so a thorough medical evaluation and genetic counseling is recommended for cleft patients.
How is a cleft diagnosed?
Clefting of the lip and palate is usually visible during the baby’s first examination. One exception is a submucous cleft where the palate is cleft, but remains covered by smooth, unbroken lining of the mouth. A child with cleft lip or palate is often referred to a multidisciplinary team of experts for treatment. The team may include: an otolaryngologist (ear, nose, and throat specialist), plastic surgeon, oral surgeon, speech pathologist, pediatric dentist, orthodontist, audiologist, geneticist, pediatrician, nutritionist, and psychologist/social worker.
How are clefts treated?
Treatment of clefts is highly individual, depending on the overall health of the child and the severity and location of the cleft(s). Multiple surgeries and long-term follow-up are often necessary. Because clefts can interfere with physical, language and psychological development, treatment is recommended as early as possible. Surgery to repair a cleft lip is usually done between 10 and 12 weeks of age. A cleft palate is repaired through a procedure called palatoplasy, which is done between nine and 18 months. Additional surgeries are often needed to achieve the best results. In addition to surgery, the child may receive follow-up care from members of the multidisciplinary team on issues of speech, hearing, growth, dental, and psychological development.
What are the complications of a cleft lip?
The complications of cleft lip and cleft palate can vary greatly depending on the degree and location of the cleft. They can include all or some or all of the following:
Breathing: When the palate and jaw are malformed, breathing becomes difficult. Treatments include surgery and oral appliances.
Feeding: Problems with feeding are more common in cleft children. A nutritionist and speech therapist that specializes in swallowing may be helpful. Special feeding devices are also available.
Ear infections and hearing loss: Any malformation of the upper airway can affect the function of the Eustachian tube and increase the possibility of persistent fluid in the middle ear, which is a primary cause of repeat ear infections. Hearing loss can be a consequence of repeat ear infections and persistent middle ear fluid. Tubes can be inserted in the ear by an otolaryngologist to alleviate fluid build-up and restore hearing.
Speech and language delays: Normal development of the lips and palate are essential for a child to properly form sounds and speak clearly. Cleft surgery repairs these structures; speech therapy helps with language development.
Dental problems: Sometimes a cleft involves the gums and jaw, affecting the proper growth of teeth and alignment of the jaw. A pediatric dentist or orthodontist can assist with this problem.
Frequently Asked Questions
Cleft lip refers to a split or separation in the upper lip only, accounting for about 20% of all clefts. Cleft palate involves a split in the roof of the mouth and accounts for roughly 30% of clefts. Cleft lip/palate means both the lip and palate are cleft and represent about 50% of all clefts. Each type varies in severity and impact on feeding, speaking, and breathing.
Clefts are believed to result from a combination of genetic inheritance, environmental factors, and genetic syndromes. These may include inherited genes from parents, exposure to toxins during early pregnancy, and being part of a genetic syndrome. About 30% of cleft cases are associated with syndromes like Waardenburg or Down syndromes.
Most clefts are visible during a newborn's first examination. Some, like submucous cleft palate, may not be obvious as the palate's surface covering is intact. Diagnosis often leads to referral to a multidisciplinary team including specialists such as plastic surgeons, speech pathologists, and geneticists for comprehensive evaluation.
Treatment is personalized and usually involves multiple surgeries and long-term follow-up. Cleft lip repair is typically done between 10 to 12 weeks of age, while cleft palate repair (palatoplasty) occurs between 9 and 18 months. Additional therapies such as speech therapy, dental care, and hearing management are part of comprehensive care.
Complications vary with severity but may include difficulties in breathing, feeding problems, recurrent ear infections leading to hearing loss, speech and language delays, and dental issues with tooth growth and jaw alignment. Specialized interventions like ear tubes, feeding support, speech therapy, and orthodontics help manage these problems.
Yes, cleft lip/palate is more common in Asian populations and certain American Indian groups and occurs less frequently in African Americans. Cleft lip/palate is more common in males, while isolated cleft palate occurs equally among racial groups but is more frequent in females.
Early treatment is crucial because clefts can interfere with feeding, breathing, speech development, and psychological growth. Prompt surgical repair and supportive therapies help improve physical function and developmental outcomes, reducing complications associated with delayed care.
