Cleft lip and cleft palate
Modern medicine has developed surgical corrections for cleft lip and palette.
Natural structures form in the body and fuse together while a fetus develops in the womb. If they do not fuse, a gap results called a cleft.
The Centers for Disease Control and Prevention (CDC) estimate that, in the United States, around 2,650 infants are born annually with a cleft palate. Around 4,440 babies develop a cleft lip each year, which might occur with or without a cleft palate.
Among the 15 types of clefting that might occur in the mouth and face, cleft lip and cleft palate account for between 50 and 80 percent of these congenital anomalies, and it is one of the most common in the U.S.
What is a cleft?
A child may develop speech problems if they do not receive treatment for their cleft.
A cleft is a fissure or gap.
The cleft in the lip may be small, or partial, and look like an indentation on the lip. A complete cleft can extend to the nose.
A unilateral cleft occurs on either the right or left side of the upper lip. A bilateral cleft affects both sides.
A cleft palate occurs when the two parts of the skull that form the hard palate do not fuse together. The soft palate also has a gap, or cleft.
A person with a complete cleft palate may also have a gap in the jaw, while an incomplete cleft palate looks like a hole in the roof of the mouth.
With modern surgery, most cases can be corrected with minimal scarring.
If not corrected, a cleft lip or palate can lead to:
- dental problems
- ear infections and possible hearing loss
- feeding difficulties
- low self-confidence
- speech problems
A team of specialists, from the family physician to a speech therapist, will work to help a child with a cleft, because it can cause a range of developmental issues.
During the first 12 weeks of pregnancy, the skull of the fetus is developing.
Two separate plates of bone and tissue form and gradually move towards each other. At this point, they join, or fuse, at the mouth and nose to form the skull.
Incomplete fusion will result in a cleft.
Certain genes make a cleft more likely in some people than in others.
Although most parents with a cleft do not pass one on to their children, clefts are common in people who are close relatives.
According to the CDC, certain medicines for epilepsy, such as topiramate or valproic acid, can increase the risk of a cleft lip if a woman who is pregnant uses them during the first 3 months of gestation.
Surgery can close a cleft lip, enabling the child to speak and eat without difficulties.
A range of interventions is available for children born with a cleft.
An orthodontist may start to repair the palate and bring the lips together within a week of birth.
This treatment, called nasoalveolar molding (NAM) aims to prepare the infant for future surgery.
Surgery to close the cleft lip may take place within 3 to 6 months of birth. An infant will generally receive treatment for a cleft palate between the ages of 9 and 18 months.
This should enable the child to speak and eat without further difficulties.
Corrective surgery can help realign the jaw.
In cases where a child needs surgery to correct the jaw, some doctors prefer to wait until the child reaches the ages of 10 to 12 years before performing the surgery.
Waiting for all adult teeth to develop before the surgery may prevent the need for corrective surgeries further down the line.
Other specialists prefer to correct the jaw earlier on, arguing that speech therapy is less effective when the patient is older.
Most children with a cleft lip or palate will need a combination of surgical methods and operations as they grow.
The cleft sometimes reaches the maxillary alveolar ridge, the edge along which the upper jaw meets the teeth. When this occurs, the surgeon takes bone tissue from another part of the body, such as the hip, and uses it to fill the cleft.
In many countries, a cleft palate or craniofacial team monitors the infant until they reach adulthood. For some people, monitoring might continue for life.
Scarring from modern cleft surgery is often minimal, but the individual may receive further surgery later in life to cosmetically correct remaining scar tissue.
Speech and hearing
Cleft lip and cleft palate can impact speech due to the central role of the lips, palate, and tongue in forming words.
The anomaly can lead to a higher risk of ear infections, which can damage hearing.
Tympanostomy tubes may help to prevent fluid build-up in the middle ear.
A speech-language pathologist can help solve speech problems. The child may need other types of surgery alongside cleft repair to reduce the amount of air that escapes through the nose during speech.
The speech therapist may also help the child correct speech issues present from before the repair.
Children with a cleft learn to compensate when speaking. After repair, they have to learn new ways of forming words.
Nowadays, a child with a cleft is more likely to have effective corrective surgery at an early age, reducing the social impact and self-image issues a cleft lip or palette might cause.
Even so, a child may need encouragement to interact with other children from an early age. Other children may ask why the appearance of a person with a cleft lip is different. A child with a cleft should be able to explain the condition to their friends.
If the cleft causes hearing and speech problems, it is important for parents or carers to discuss these with the school. The teachers can then make sure the child sits in a seat from which it is easier to see and hear.
A child with cleft lip or palate may need orthodontic braces to straighten and reposition the teeth.
Children with cleft lip or palate tend to experience more problems with their teeth than other children.
The alveolar ridge, a ridge of bone that supports the upper teeth and gums, might not fully develop.
The child may need orthodontic braces to straighten and reposition teeth.
Tooth decay is more common among children with cleft lip, cleft palate, or both. Maintaining good oral hygiene can help reduce the risk of decay and dental problems.
A cleft palate can be challenging for both parents and children, but corrective surgery and other interventions are now widely available.
There is no way to prevent a cleft palate, but avoiding alcohol and tobacco during pregnancy can reduce the risk of a cleft and other problems. Check with a physician before taking any medications during pregnancy.
If clefts run in one or both parental families, parents can also seek genetic counseling before pregnancy to help them to understand the risk of having an infant with cleft palate.
A cleft lip or palate is a congenital anomaly in which a gap develops in either the upper lip or the roof of the mouth.
The condition occurs when bones in the skull do not correctly fuse together while a fetus develops.
It can lead to difficulties with speech, feeding, and hearing, as well as an altered facial appearance. These can impact an infant's confidence, self-image, and social life.
Corrective surgery is available and various therapies, including speech therapy and tympanostomy tubes, can help restore function to hearing and speech. Children with a cleft palate might also require further dental work.
The condition can have a considerable impact on a child's wellbeing in the early years, but the outlook is normally very good.
What are the long-term effects of a cleft lip after receiving corrective surgery?
If a child has a cleft lip and no cleft palate, surgery usually occurs within the first year.
After that, the child can lead a life similar to that of a person born without a cleft. They will still need to follow up with their surgeon and craniofacial team if they have one and may face a higher risk of ear infections and hearing problems.
They will also need to pay good attention to dental hygiene, as they will be at higher risk for tooth decay and dental problems. Children with clefts are more likely to need orthodontic care as they get older.
Some children need another surgery later in life for their cleft lip.Karen Gill, MD Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.