What is cleft lip and cleft palate?

Early pregnancy is when 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 or cleft palate or both.

In this article we will look at what a cleft lip and palate are, the causes and the treatments available.

📝 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 condition 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 portion of the roof 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, the lips join, and around the seventh or eight week the palate joins. This joining process may fail completely or stop at any point, resulting in a cleft.

📝 What kind of problems 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
• Feeding difficulties. Feeding difficulties occur more with cleft palate abnormalities. The infant may be unable to suck properly because the roof of the mouth is not fully formed
• Speech problems. Muscle function may be reduced due to the opening of the roof of the mouth and the lip, leading to a delay in a child’s speech. 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 future children with cleft lip and cleft palate.

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

🩺 Diagnosis

A cleft lip may be picked up during pregnancy during a routine prenatal ultrasound. After the birth of the baby it will generally be visible during a baby’s first examination. However some types of cleft palate aren’t easily visible and might not be diagnosed until later in life.

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

🏥 Treatment

Surgery

Surgery can treat both 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 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.

💡 Tips

As a parent seeing your child struggling is upsetting and distressing. Here are a few tips to help:

• Always ask for help and advice from your healthcare team, especially if your baby has problems nursing or drinking from a bottle. There are many ways to overcome feeding challenges
• Always ask questions if you are unsure. Talk to the people who are treating your baby and ask them to explain what you don’t understand
• Lean on family, friends and other parents of children with cleft lip and palate for support

📝 Conclusion

Cleft lip and cleft palate are birth defects in a baby’s lip and mouth resulting in feeding, speech, hearing and dental problems. The causes of cleft lip and palate are not clear, but are likely to be a combination of genetic and environmental factors. Smoking, medical conditions such as diabetes and taking certain medicines can increase the risk. Cleft lip and cleft palate repair can be done through surgery early in life and in the vast majority of cases, surgery is very successful.

Sources

• Cleft lip and palate – NHS
• Cleft Lip & Cleft Palate: Causes & Treatment
• Cleft Lip/Cleft Palate | Birth Defects | CDC
• Cleft Lip & Palate Association