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Cleft Lip and Palate 
 
 

Cleft Lip and Palate

What are Cleft Lip and Cleft Palate?
Treatment of Cleft Lip and Cleft Palate

Approximately one out of 600-650 babies is born with a cleft lip and/or palate making it one of the most common congenital birth defects. This condition occurs early on in pregnancy during formation of the face when the tissues of the lip and/or roof of the mouth, the palate, do not fully fuse.

Cleft Lip and Palate

What are Cleft Lip and Cleft Palate?

Defects can be bilateral (affect both sides of the lip) or unilateral (one side only). Clefts can also range in severity, from a small notch in the lip or slit at the back of the palate to complete involvement of the entire lip and palate with a wide space in between that affects the shape of the nose as well.

Although the cause is not always fully understood in each patient, cleft lip and/or palate is thought to result from a combination of genetic (inherited) and environmental factors including malnutrition and exposure to toxins or illness during pregnancy. In some cases cleft lip and/or palate can be associated with other congenital syndromes.

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Treatment of Cleft Lip and Cleft Palate

Feeding

Sometimes cleft lip and palate can be diagnosed on a prenatal ultrasound. Otherwise, the condition is detected at birth. Infants with cleft lip and (especially) cleft palate need to be followed carefully during feeding. It can be harder for them to generate enough suction to extract an adequate amount of milk and/or they can lose fluid through the hole in the palate into their nose. Usually, a specialized bottle that has larger holes in the nipple and lets parents squeeze it to help deliver fluid easier are used. Our feeding therapist will work with you and your baby to help you master a healthy feeding routine.

Click here for a helpful feeding video. If you need bottles, please contact debbie_watters@ssmhc.com.

Speech

The palate also plays an important function in speech production. Patients with cleft palate can have problems with speech development due to many different causes including short palate length, dysfunction of the palate muscles, and nerves or behavioral causes. Our experienced speech pathologist specializes in the care of cleft patients and will follow your child from early speech development through the years to monitor his/her progress, provide therapy and guidance as well as help diagnose the need for any further interventions.

Hearing

Children with cleft palate can also have dysfunction of the Eustachian tubes leading to chronic fluid in the middle ear. If untreated, this can cause problems with chronic infections and hearing loss. Your baby will be followed early on by the otolaryngology (ear, nose and throat) surgery team for this condition which is readily managed by placement of ear tubes to allow drainage of fluid. In addition, our cleft team includes experienced audiologists that will follow your child’s hearing through the early years to allow early detection and referral if hearing loss is detected.

Teeth

Cleft patients can have dental problems ranging from crooked to missing or malformed teeth as well as poor development and growth of the jaws that can affect the overall alignment of the bite. This is of greater concern when the cleft involves the alveolus (bony arch that holds the teeth). The experienced pediatric orthodontists on the cleft team will follow your child throughout this treatment process to allow a coordinated approach to maintain oral health and ensure proper orthodontic/surgical correction.

Surgical Treatment and Approximate Timeline

The treatment of cleft lip and palate is customized to your child’s specific condition, with stages timed to allow for optimal reconstruction of the tissues without disturbing facial or dental growth. Here is a summary and generalized timeline of the basic stages your child may require. However, only your doctors can determine exactly what treatment your child will need. Although there may be multiple stages, our experienced cleft team is there to provide guidance and support throughout your child’s development to promote a healthy result both physically and emotionally.

     10 weeks or older – Repair of the soft tissues of the lip and nose

  • Before this surgery, if your child has a wide cleft, he/she may be fitted with an orthodontic appliance that allows shaping of the alveolar segments (bony arch that will hold the teeth).
  • Taping of the lip may also be taught to help narrow the space in preparation for surgery.
  • After surgery, your baby will be followed as he/she grows for proper scar management and narrowing of the palatal cleft with growth.

     Around 1 to 1.5 years old – Repair of the palate

  • Prior to palate repair, your child will be followed for proper feeding and growth. Cleft size will also be monitored in order to plan timing of the repair.
  • After repairing the soft tissues of the palate, your child will need to attend follow-up visits every 6 months to yearly as he/she grows to follow tooth and speech development.
  • Some children with cleft palate may require another palatal surgery in earlier childhood to help improve speech.
  • Regular checkups with a pediatric dentist and speech therapist are important to ensure proper development.

     During childhood when permanent teeth begin to come in – Orthodontic consultations

  • Orthodontic consultation occurs when the permanent teeth begin to come in to assess the need for first phase treatment to expand the alveolus and allow more room for the teeth.
  • If the gum, or alveolus, has a cleft through it, surgery will be planned to close the gap using bone graft from the hip. This typically occurs when the permanent teeth begin to come in (about ages 7 - 10) so there is better bony support of the teeth.
  • The orthodontist will continue to follow your child as more permanent teeth appear, using braces and other techniques to maximize oral health and appearance.

     Later in life, as facial growth is completed – Further treatment of related issues

  • Nasal surgery to correct a deviated (twisted) septum and improve breathing as well as further shape the nose may be required.
  • Some patients have inadequate jaw growth that affects the alignment of the teeth and bite that may require surgery for correction.
  • Touch-up procedures that improve the shape or fullness of the lip as it changes with growth are timed according to the patient’s input and desires.

Cleft lip and palate is a relatively common and treatable condition that requires specialized team care. Together we can promote a happy and healthy development for patients with cleft lip and/or palate and their families.

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