Can cleft lip and palate be detected on an ultrasound?

In the first trimester of pregnancy different parts of a baby’s face start to develop separately and then join together. If some parts do not fuse properly a space in the upper lip or palate forms, resulting in a baby born with a cleft lip and palate, cleft lip only or cleft palate. Facial clefts can often be diagnosed during pregnancy, but soft palate clefts are extremely difficult to detect on ultrasound scans and can only be confirmed once a baby is born. A 3D ultrasound scan may be offered to see your baby’s face in more detail. Lets take a look at how a cleft lip and palate can be detected by ultrasound, including it causes and treatment.

📝 What is a cleft lip & palate?

A cleft is a gap created when the different parts of a baby’s face don’t fully join together in the womb. It is a craniofacial birth defect which someone is born with.

Cleft lip

A cleft lip is a gap in the upper lip. It can affect one side or both sides of the lip or the middle. This can range from a small notch to a total separation of the upper lip, which can extend up to the nose.

A cleft palate is a gap in the roof of the mouth. It can affect some or all of the soft palate (the back of the mouth) and may extend into some or all of the hard palate (the bony front portion of the roof of the mouth). Clefts of the lip and palate can occur separately or together.

Cleft lips and palates occur during early pregnancy. Around the fifth or sixth weeks of pregnancy, when the lips join and around the seventh or eight week when the palate joins. This joining process may fail completely or stop at any point, resulting in a cleft.

Different types of cleft

Cleft lip and cleft palate may look like:

• A split in the lip and palate that affects one (unilateral cleft) or both sides (bilateral cleft) of the face
• A split in the lip that appears as only a small notch in the lip or extends from the lip through the upper gum and palate into the bottom of the nose
• A split in the roof of the mouth that doesn’t affect how the face looks

Prenatal ultrasound

Can you tell if baby has a cleft lip by ultrasound?

Cleft lip can be be detected using ultrasound scans during pregnancy. This scan is usually done between weeks 18 and 22 of pregnancy. Diagnosis of cleft lip is easier to identify because of the visible physical changes in the baby’s face.

Can a cleft palate be missed by an ultrasound?

A cleft palate is a gap in the roof of the mouth. An isolated cleft palate (without a cleft lip) is sometimes challenging to see and can be missed on an ultrasound. A cleft can affect the soft palate or both the soft and hard palate.

Genetic counselling

If detected, parents are counselled regarding the condition and the family may also be referred for genetic counselling and other tests. At this stage your healthcare provider may recommend amniocentesis to check for associated genetic conditions. Amniocentesis is a procedure to remove amniotic fluid from the amniotic sac.

Also, families with a history of cleft palates should seek genetic counselling to determine their risks for giving birth to a child with a cleft palate.

📝 What kind of complications do cleft lip and palate cause?

• Ear infections and hearing loss. Ear infections are often due to problems with the tube that connects the middle ear and the throat. A build-up of fluid in the ears (glue ear) can also lead to hearing problems and need a hearing aid
• Feeding difficulties. Feeding difficulties occur more with cleft palate abnormalities. A baby with a cleft lip and palate may be unable to breastfeed or feed from a normal bottle because they cannot form a good seal with their mouth
• Speech problems. Muscle function may be reduced leading to a delay in language development. Speech therapy may be recommended
• Dental problems. The abnormalities around the mouth may lead to teeth not developing normally, orthodontic treatment may be required

📝 What is the main cause of cleft lip and palate?

The exact reason why this happens to some babies is often unclear but here are some possible risk factors:

Genes

Having a family history of cleft lip or palate increases the chance of your child having this condition. A healthcare professional may refer you to a genetic counsellor who can help figure out your risk of having children with cleft lip and cleft palate in the future.

Genetic syndromes

Cleft lip or palate are found in more than 400 syndromes, including Pierre Robin and Down syndromes. Approximately 30 percent of cleft defects are associated with a genetic syndrome.

Environmental factors

There are things that can happen just before or during pregnancy:

• Taking medication. Certain medications such as anti seizure drugs, some acne treatments and methotrexate, a drug commonly used for treating cancer, arthritis and psoriasis can increase the risk of cleft lip and palate
• Smoking
• Health conditions such as diabetes, obesity, folic acid deficiency
• Exposure to certain viruses or chemicals during pregnancy

🏥 Treatment

After diagnosis the paediatrician will explain your child’s condition, discuss the treatments they need and answer any questions you have. The paediatrician will work together with a cleft team, consisting of am otolaryngologist, plastic surgeon, oral surgeon, speech therapist, paediatric dentist, orthodontist, audiologist, nutritionist, and psychologist/social worker to put in place a treatment plan:

Cleft palate repair

Surgical repair can treat cases of cleft lip and cleft palate, but as every cleft is unique treatment depends on the extent of the cleft, the child’s age and any health conditions.

Cleft lip reconstructive surgery usually occurs in the first few months of life. It is recommended within the first 12 months of life.

Cleft palate surgery is recommended within the first 18 months of life. This is a more complicated surgery and it is done when the baby is slightly older and can tolerate the surgery. Many children will need additional surgical procedures as they get older.

📝 Conclusion

Surgery for cleft lip and palate is highly successful in most cases, especially when performed by experienced surgeons in specialist centres. In some cases additional support, such as speech therapy, hearing aids or orthodontics are needed. With the right medical care, most children born with clefts go on to lead healthy, active lives.

Sources

• Cleft lip and palate – NHS
• Cleft lip and cleft palate – Diagnosis and treatment – Mayo Clinic
• Cleft Lip/Cleft Palate | Birth Defects – CDC
• Cleft Lip & Cleft Palate: Causes & Treatment
• Use of folic acid supplements and risk of cleft lip and palate in infants: a population-based cohort study – PMC