Cleft Lip and Cleft Palate – Surgery, Causes, Repair, Ultrasound

Key Facts

• Cleft lip and cleft palate are congenital deformities occurring when parts of the lip or palate do not fuse properly during early fetal development
• Approximately 1 in 700 babies is born with a cleft lip, a cleft palate, or both
• Both genetic and environmental factors contribute to the development of clefts
• Various treatments, including surgery and therapy, can help correct cleft lip and palate
• Early intervention and proper management can yield excellent outcomes for individuals with cleft lip and palate

What is Cleft Lip and Cleft Palate?

Cleft lip is a physical split or opening in the upper lip. The cleft can range from a small notch to a large gap that extends up into the nose. It can occur on one or both sides of the lip and is the result of the tissue that makes up the lip not joining completely before birth.
Cleft palate is a split or opening in the roof of the mouth (palate). Like a cleft lip, a cleft palate can be on one side or both sides of the palate. It can involve just the back part of the palate (soft palate) or both the front and back parts (hard and soft palate).

What Does a Cleft Lip and Palate Look Like?

A cleft lip usually appears as a narrow opening or gap in the skin of the upper lip. It can sometimes extend all the way to the nose. A cleft palate appears as an opening in the roof of the mouth. When both are present, there can be a gap that extends from the lip to the palate.

Other Problems related to cleft lip/palate

Children with cleft lip and palate can experience other problems such as:

• Difficulty in feeding: Children with cleft lip and palate often face difficulty in feeding (difficulty creating suction needed for breastfeeding or bottle-feeding) due to the opening in the palate
• Speech problems: The cleft can affect the development of speech organs leading to difficulties in speech, cleft palate can affect speech, causing a nasal tone
• Dental issues: Children might experience delayed eruption of teeth, malalignment, and higher susceptibility to cavities
• Hearing problems and ear infections: With cleft palate are at an increased risk for middle ear infections, which can sometimes cause hearing loss
• Social and emotional challenges: The appearance and speech issues can lead to self-esteem issues and social isolation

How Do Doctors Fix a Cleft Lip and Cleft Palate?

Cleft Lip Repair Surgery to repair a cleft lip is generally performed when the baby is several months old. This involves closing the separation and providing a more normal shape and function for the lip.
Cleft Palate Repair: Surgery to repair a cleft palate is performed between 6 and 18 months of age. This surgery is more complex and aims to close the gap in the palate.

Causes of Cleft Lip and Palate

While the exact cause is unknown, cleft lip and palate are thought to be caused by a combination of genetic and environmental factors. Some cases have been linked to family history, while others are related to certain genetic conditions. Environmental factors such as smoking during pregnancy, diabetes, or the use of certain medications during pregnancy can also contribute.

What Can You Do to Help Prevent Cleft Lip and Cleft Palate in Your Baby?

• Take Folic Acid: Taking 400 micrograms of folic acid daily before and during early pregnancy can help lower the risk.
• Don’t Smoke or Drink Alcohol: Avoiding tobacco and alcohol during pregnancy reduces the risk.
• Get a Preconception Checkup: Seeing a healthcare provider before pregnancy can help in managing health conditions and medications that might affect a developing baby.
• Get to a Healthy Weight Before Pregnancy: Being at a healthy weight reduces risks for complications during pregnancy.
• Talk to Your Provider: Discuss medications and supplements with your healthcare provider to make sure they are safe during pregnancy.
• Early and Regular Prenatal Care: When pregnant, get early and regular prenatal care.

Risk Factors of Cleft Lip and Palate

Risk factors include:

• Family history of cleft lip or palate
• Presence of another birth defect
• Use of tobacco or alcohol during pregnancy
• Not consuming enough vitamins and nutrients during pregnancy

Diagnosing Cleft Lip and Palate

Cleft lip and cleft palate can sometimes be diagnosed before birth through a prenatal ultrasound. Otherwise, they are usually diagnosed immediately at birth.

Treatments for Cleft Lip and Palate

Treatment typically involves surgery to repair the lip and palate. Surgery for cleft lip usually occurs by the time a baby is 3 months old, and cleft palate is often repaired between 6 and 12 months. Additional surgical procedures may be necessary as the child grows. Speech therapy and dental care are also important parts of managing cleft lip and palate.

Will a Cleft Lip and Palate Happen Again?

Parents who have had a child with a cleft lip or palate may have an increased risk of having another child with the condition. Genetic counseling can provide more information about the risk in subsequent pregnancies.

Is a Cleft Palate or Lip Genetic?

Cleft palate and cleft lip are congenital conditions that may have a genetic component. While the exact cause is often multifactorial, studies suggest that genetics can play a significant role. Families with a history of cleft lip or palate are at an increased risk of having children with the same condition. However, environmental factors, including certain medications and lifestyle choices during pregnancy, can also contribute.

At What Age are Cleft Lip and Palate Repairs Done?

Cleft lip is usually repaired when the baby is 3 to 6 months old. Cleft palate is repaired between 6 to 18 months old.

What Nonsurgical Treatments Help Cleft Lip and Cleft Palate?

Nonsurgical treatments include speech therapy, nutritional support, and the use of dental appliances.

How Do You Prevent Cleft Lips or Palates in Babies?

Prevention includes taking prenatal vitamins, maintaining a healthy lifestyle, avoiding smoking and alcohol, and getting regular prenatal care.

What’s the Outlook for Children Who Have Cleft Lip or Cleft Palate?

With early intervention and ongoing care, many children with cleft lip and palate grow up to have normal lives. Surgical repair can improve the ability to eat, speak, hear, and breathe and can create a more normal appearance and function. They can have effective speech, normal hearing, and a positive self-image.

Do Cleft Lips or Palates Go Away?

Cleft lips and palates do not go away on their own; they require surgical correction and comprehensive care.

How Should the Dental Care Needs of Children with Cleft Lips or Palates Be Met?

Early Dental Care: Introduce the child to dental care early to address any dental issues.
Orthodontic Care: Orthodontic intervention might be required to correct malocclusion.
Prosthodontic Care: Prosthetic devices such as obturators can be used to close defects in the palate.

Diet After Surgery

After surgery, it’s important to adhere to a soft diet to avoid irritating the surgical site. Proper hydration is also essential.

Activity After Surgery

Children should avoid strenuous activity after surgery. Adhering to the surgeon’s post-operative instructions is crucial for healing.

How Many Babies are Born with Cleft Lip/Cleft Palate?

Approximately 1 in every 700 babies is born with a cleft lip or cleft palate worldwide. This makes it one of the most common birth defects.

Bottom line

Cleft lip and cleft palate are birth defects that can be effectively managed through early intervention and comprehensive care. Affected individuals can lead fulfilling lives with proper support and treatment.

This article is complete and was published on June 19, 2023, and last updated on January 25, 2024.