Cleft lip and cleft palate are structural abnormalities that start during fetal development. Without treatment, a cleft can make speaking and eating difficult and lead to various other challenges. However, early surgery can usually correct a cleft.
Doctors do not know exactly why a cleft occurs. As a baby develops in the womb, the structures that form the lip and roof of the mouth join. In some cases, this does not happen correctly, resulting in a cleft.
A cleft can make it difficult to speak and feed. It can also increase the risk of ear infections and problems with the teeth and hearing.
Cleft lip and cleft palate are among the
A cleft is a gap. Clefts commonly affect the lip or the roof of the mouth, known as the palate.
The extent of a cleft can vary widely. Some small clefts in the lip just look like an indentation, whereas others can extend to the nose. A cleft can be unilateral and affect one side of the lip, or it can be bilateral and affect both sides.
A cleft palate occurs when the two parts of the skull that form the hard or soft palate do not fuse. If this happens in the front of the mouth, it results in a gap in the hard palate. If it affects the back of the mouth, there will be a cleft in the soft palate.
The extent of a cleft palate can also vary. A cleft palate may look like a small opening at the back of the mouth, or it may separate the sides of the palate from the front to the back of the mouth. In some cases, there is also a cleft in the jaw.
Sometimes, the lining of the roof of the mouth hides a cleft, meaning that it is not visible. This can happen with a submucous cleft palate, where the skin covers a cleft in the muscles. The gap can lead to speech problems, such as difficulty making the sounds “p” and “s.” Drinks and soft foods, such as yogurt, may move up into the nasal cavity and come out through the nose.
Surgery can usually correct a cleft lip or cleft palate.
The following slideshow contains images of cleft lip and cleft palate before and after surgery.
Without treatment, a cleft lip or palate can lead to:
- feeding difficulty
- problems with dental development
- a higher risk of tooth infections
- ear infections
- possible hearing loss
- unclear speech or speech that sounds unusual
- breathing difficulties
- a risk of aspiration, or taking food into the lungs
Having a cleft lip or cleft palate may also affect a person’s self-esteem, but
Doctors do not know precisely why some children are born with a cleft, but it happens when structures in the mouth do not form as they should while the skull is developing.
The lip forms between the
The roof of the mouth, or the palate, develops between the sixth and ninth weeks of pregnancy. As with the lip, a gap can form if the two sides do not join. In some babies, the gap affects only part of the palate. In others, it may affect the whole palate.
Other risk factors are associated with the pregnancy. A pregnant person can minimize the likelihood of a cleft affecting the baby by:
- refraining from smoking and avoiding secondhand smoke, where possible
- avoiding drinking alcohol
- working with a doctor to manage their weight safely, if they have obesity
- taking enough folic acid
- avoiding certain medications during pregnancy, such as steroids
- refraining from using antiseizure drugs, such as topiramate or valproic acid, in the
first 3 monthsof pregnancy
Most cases of a cleft are not hereditary, but if one child is born with a cleft, there is a 2–8% chance of a sibling also having a cleft.
Various treatment options are available for a cleft lip or cleft palate.
For a cleft lip, an infant will usually have surgery at the age of
For a cleft palate, possible interventions include:
- nasoalveolar molding, in which an orthodontist starts to repair the palate and bring the lips together within a week of birth, in preparation for future surgery
- surgery, usually within
- further surgery if necessary as the child grows older, such as a procedure to realign the jaw at about
The type of surgery depends on the extent of the cleft. If a cleft reaches the maxillary alveolar ridge, the edge along which the upper jaw meets the teeth, the surgeon takes bone tissue from another part of the body, such as the hip, and uses it to fill the cleft.
The benefits of surgery include:
- improving the appearance of a cleft
- allowing the teeth to develop
- improving speech
- reducing the risk of ear and hearing problems
- helping with breathing, in some cases
A person born with a cleft palate may receive monitoring and support until adulthood from a multidisciplinary team.
The team may offer:
- speech and language therapy
- feeding support
- orthodontic treatment
- monitoring for hearing problems and ear infections
- family support
An ultrasound scan at around
In some cases, the cleft does not become apparent until later in life. This may happen with a submucous cleft palate.
There is no way to prevent a cleft palate, but avoiding alcohol and tobacco during pregnancy may help reduce the chance of a cleft and other health problems. A person should check with a physician before taking any medications during pregnancy.
If one or more close relatives were born with a cleft, parents may wish to seek genetic counseling before pregnancy to help them to understand the likelihood of it affecting the baby. The parents of a child with a cleft may be interested in receiving genetic counseling before trying for another child.
A cleft lip or palate is a congenital feature in which a gap develops in either the upper lip or the roof of the mouth. It happens when structures in the skull do not correctly fuse during fetal development.
It can lead to difficulties with speech, feeding, and hearing, as well as an altered facial appearance. These challenges can affect a child’s confidence, self-image, and social life. However, surgery is usually effective, and other therapies can help monitor and prevent issues with teeth, speech, hearing, and feeding.
The condition can have a considerable impact on a child’s well-being in the early years, but the outlook is usually excellent, with most children going on to live a full and healthy life.