Splits or openings in the upper lip, palate (roof of the mouth), or both are called cleft lip and cleft palate. This condition occurs when the upper lip and palate do not close completely in the baby during pregnancy.
Furthermore, cleft lip and palate are considered common birth defects that may happen on their own or together. While certain syndromes can cause these birth defects, sometimes it is not possible to determine the exact cause.
These birth defects are upsetting, but there are treatments available to correct them. Usually, after several surgeries, the palate and lips work as they should, and the baby looks much better. In some cases, slight scarring may happen.
Symptoms
Commonly, a cleft in the palate or lip can be noticed right after birth, or it can be identified during pregnancy by using an ultrasound. A cleft lip or palate usually looks in the following ways. For example:
- It negatively affects one or both sides.
- While it may appear as a small notch in the lip only, a cleft may extend through the upper gum and palate to the nose.
- Some babies develop a cleft palate (roof of the mouth) that does not affect how the face looks.
In rare cases, a cleft happens in the muscles of the soft palate only. These muscles are located in the back of the mouth and are covered with the mouth’s lining. In such cases, the condition is called submucous cleft palate. Sometimes, this condition type may not be diagnosed during pregnancy or at birth, but later, when the following problems begin. Examples include:
- Recurrent ear infections
- Nasal speaking voice
- A hard time feeding
- Swallowing problems (rarely)
If you notice any of the previous symptoms after birth, do not hesitate to see a doctor.
Causes
This birth defect happens when tissues of the mouth and face do not develop properly before birth. In normal circumstances, the tissues of the lip and palate connect in the first few weeks of pregnancy, but in babies with this condition, they never connect, forming an opening.
In most cases, physicians cannot determine the exact cause of cleft lip or cleft palate. However, they think certain abnormal genes and environmental factors may contribute to it.
In addition, the biological parents may have the abnormal gene that causes this condition, either alone or as part of a genetic syndrome. Sometimes, unborn babies may get a mutated gene that makes them more likely to develop a cleft lip or palate.
Risk Factors
There are some factors that may increase the risk of developing a cleft lip or cleft palate. For example:
- Family history – If you have a parent or sibling with a cleft lip or palate, the baby’s risk significantly increases.
- Constant exposure to certain substances during pregnancy – The risk of a cleft lip or cleft palate increases if the biological mother drinks alcohol, uses tobacco products, or takes high doses of certain medicines during pregnancy.
- Lack of vitamins during pregnancy – For instance, if you have reduced levels of folate in the body during the first trimester of pregnancy, it may increase the risk of your baby for this condition.
Generally, men are more likely to develop a cleft lip with or without cleft palate, but females are more prone to develop a cleft palate without a cleft lip. This birth defect occurs mostly in people of Native American or Asian heritage in the U.S.
What Are The Potential Complications of Cleft Lip and Cleft Palate?
Those who develop this birth defect may experience multiple complications. For example:
- A hard time feeding (for example, most babies with a cleft lip can breastfeed, but a cleft palate may make it hard to suck)
- Frequent ear infections – They are more likely to develop middle ear infections, which may lead to hearing loss.
- Dental problems – In some cases, a cleft extends to the nose that prevents the teeth from developing properly.
- Speaking problems – Babies with a cleft palate make different sounds compared to those with a normal palate. Their speech has a nasal sound frequently.
- Difficulty coping with health conditions – People with a cleft lip or cleft palate may experience social, behavioral, and emotional problems because they look different.
How to Prevent Cleft Lip and Cleft Palate?
While this birth defect cannot be prevented, there are some tips that may lower the risk. For example:
- Genetic counseling – People with a family history of cleft lip or cleft palate you discuss with their healthcare providers about the risks before pregnancy. They may determine the risk of having children with this birth defect.
- Prenatal vitamins – If you’re planning to get pregnant soon, consult with your doctor about vitamins that you should take before pregnancy. However, vitamins and minerals are very important, and reduced levels may cause other problems to your unborn baby as well.
- Avoid tobacco products and alcoholic drinks during pregnancy – Do not use tobacco or alcoholic products during pregnancy because they significantly increase the risk of multiple health problems to the baby, not only for this birth defect.
Diagnosis
Commonly, a cleft palate or cleft lip is noticed right after birth, which means specific tests are not needed. This birth defect can be diagnosed with an ultrasound during pregnancy.
Ultrasound during Pregnancy
This test is also called a prenatal ultrasound, and it is used to make images of the unborn baby. Thereafter, physicians can determine abnormalities in the facial structures according to these pictures. Usually, doctors perform a prenatal ultrasound to check for a cleft lip or cleft palate in the 13th week of pregnancy. When this birth defect is identified, physicians may plan for care before birth.
Genetic Counseling
When this condition is diagnosed, your doctor refers you to a genetic counselor. They will perform a test called amniocentesis. During this test, doctors will take a small sample of the amniotic fluid to check for inherited genetic syndromes or other causes of this birth defect. Usually, to identify the exact cause of a cleft lip or cleft palate is not possible.
Treatment
The treatment goals are to make it easier to eat, speak, hear, and improve the look of the face. Commonly, for a cleft lip or cleft palate treatment, a team of healthcare professionals is involved. These include:
- Surgeons specialized in cleft repair (including plastic surgeons)
- Oral surgeons
- ENT doctors (also called otolaryngologists or otorhinolaryngologists)
- Pediatricians
- Nutrition or breastfeeding consultants
- Orthodontists
- Nurses
- Pediatric dentists and sleep medicine specialists
- Hearing specialists
- Genetic counselors
- Psychologists
- Social workers and others
The primary treatment for a cleft lip or cleft palate is surgery to repair it and therapies to ease the symptoms.
Surgery
Procedures to repair a cleft are usually performed differently based on the child’s situation. Usually, doctors recommend several surgeries that help improve speech and face look better. Surgeons often perform the surgeries in the following ways. For example:
- Between 3 to 6 months of age (cleft lip repair)
- In most cases, it occurs around 1 year after any cleft lip repair. Generally, it can be performed between 9 and 18 months of age.
- Between 2 years old and the late teen years (follow-up surgeries)
The procedures to repair a cleft lip or cleft palate usually occur in the hospital with a medicine that makes you sleep. It helps not to feel pain or be awake during the procedure. Generally, surgeons have multiple techniques to repair this birth defect. Check below what usually includes surgery to repair a cleft lip or cleft palate:
Surgery Options
- Cleft lip repair – During this surgery, they stitch both cleft sides (including lip muscles) and try to make the lip’s appearance, structure, and function more usual. In some cases, nasal repair is done during this procedure.
- Cleft palate repair – There are multiple techniques to close the opening and rebuild the palate.
- Ear tube surgery – Children with a cleft palate may require ear tubes. This helps reduce the risk of ear fluid buildup that may lead to hearing loss. The surgery involves small tubes that are placed in the eardrum to make an opening that allows fluid to drain.
- Appearance surgery – Multiple surgeries may be needed to improve the appearance of the mouth, lip, and nose.
In severe cases, children need orthodontic treatment before surgery to bring the cleft edges closer. Usually, it involves nasoalveolar molding with an orthodontic device or special taping across the cleft.
However, nasoalveolar molding is not a surgery but a procedure in which a tape is applied across the cleft. For people with a cleft palate, an additional prosthetic may be needed to align upper jaw structures (also called the maxilla).
Surgeries used to repair a cleft lip or cleft palate usually improve the child’s quality of life (including eating, breathing, and talking better). However, like other surgeries, they carry multiple risks such as infections, poor healing, bleeding, widening or raised scars, and other problems. Discuss with your doctor about the risks and benefits before surgery.
Other Treatments
Healthcare professionals may prescribe additional treatments for cleft lip or cleft palate complications. These include:
- Feeding strategies (such as a special bottle nipple or feeder)
- Orthodontic adjustments to the teeth
- Monitoring regularly for tooth development and hearing
- Psychological and speech therapies
Frequently Asked Questions
What is the difference between a cleft palate and a cleft lip?
The only difference between these birth defects is that the opening in the cleft lip usually occurs from the lip to the nose, while a cleft palate happens when an opening appears in the roof of the mouth (palate).
What causes a cleft lip?
While in most cases, it is not possible to determine the exact cause of a cleft lip or cleft palate, sometimes it happens due to a combination of genetic and environmental factors. For example:
Genetic Factors
- Abnormal genes that pass from biological parents to biological children
- Certain syndromes that may cause multiple birth defects
- Ectrodactyly ectodermal dysplasia-cleft (EEC) syndrome (this is an autosomal dominant disorder)
Environmental Factors
- Alcohol drinking or smoking during pregnancy
- Administering specific medications during pregnancy (such as anti-seizure medicines)
- Diabetes
- Do not administer prenatal vitamins (such as folic acid)
- Infections
This article does not contain all possible factors that contribute to a cleft lip or cleft palate. For more details, discuss it with your doctor.
What happens if a cleft lip is left untreated?
Infants born with a cleft lip or cleft palate may experience some complications. For example:
- Malnutrition caused by feeding difficulties
- Hearing loss
- Dental problems
- Speech delays
- Death
If you have additional questions, ask your healthcare provider.
