Cleft lip and cleft palate surgery

Cleft lip and cleft palates are birth defects where the upper lip and/or roof of the mouth do not form properly during fetal development. The result is a slit or opening on the lip or the roof of the mouth (the palate). A child can be born with a cleft lip, cleft palate, or both.

A cleft lip is typically repaired with surgery, which takes place around 3 months of age. Surgery is also performed for cleft palate, usually when the child is between six and 12 months of age.

Cleft lip types

If a child is born with a cleft lip, it may only affect one side (unilateral cleft lip) or it may affect both (bilateral cleft lip).

A cleft lip may be as mild as a notch of the lip. Or it may be as severe as a large opening from the lip to the nose. A cleft lip is often visible at birth.

Cleft lip and cleft palate can mean later complications

Children born with cleft lip and/ or cleft palate have a higher chance of developing health problems later in life, so consider proper diagnosis and treatment when the child is still young.

There are two main types of cleft palates

A normal palate has three parts. The moist, pink that lines the whole mouth is the mucosa. The mucosa covers the hard palate, which is the bony part of the roof of the mouth. The hard palate separates the nose and the mouth and makes it possible to eat, swallow, and talk. Finally, the soft palate is located in the back of the mouth. It is soft and flexible, moving up and down when we speak and breathe.

  • Complete cleft palate: There is a fissure along the entire length of the roof of the mouth, from the uvula to the hard palate.
  • Incomplete cleft palate: The cleft only occurs in part of the roof of the mouth. It may only affect the hard palate or the soft palate, or it may affect a bit of both.
    • Incomplete cleft palates may also be submucosal clefts, meaning the cleft is under the mucosa. This type of cleft palate can be hard to see.

As with cleft lips, cleft palates can affect only one side of the mouth (unilateral cleft palate) or both sides  (bilateral cleft palate). If it is a bilateral cleft palate, one side may be a complete cleft palate, while the other is incomplete.

Cleft lip and cleft palate symptoms

A cleft lip is usually visible at birth. It may appear as a small notch in one of both sides of the lip, or as a gap that extends to the base of the nose.

A cleft palate looks like a split in the roof of the mouth. It may not affect facial features. However, if the cleft palate is submucosal, it may go unnoticed until other symptoms develop. Symptoms of a submucosal cleft palate include:

  • Difficulty feeding.
  • Difficulty swallowing.
  • Food or fluid coming out of the nose.
  • Chronic ear infections.
  • Nasal voice.

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Diagnosing a cleft lip or cleft palate

Usually, cleft lip and/or cleft palate are visible and diagnosed at birth. Your  health care team can start coordinating additional medical care right away.

Child holding a stethoscope up to doctors chest while laughing

Increasingly, cleft lip and cleft palate are being diagnosed earlier on via ultrasound. At the 20-week ultrasound, a healthcare provider will do a full anatomy scan of the fetus. Depending on the position of the fetus at the time, they may be able to diagnose a cleft lip and, more rarely, a cleft palate.

People with high-risk pregnancies may have a 3D ultrasound at 20 weeks. 3D ultrasounds are highly accurate and can be used to diagnose most cases of cleft lip and cleft palate or other abnormalities. However, most people do not need this kind of ultrasound.

If your baby is diagnosed with a cleft lip or palate during an ultrasound, your doctor may recommend additional tests to determine if the cleft is related to an inherited genetic syndrome. You and your doctor will also come up with a treatment plan for when our baby is born.

Treatment for cleft lip and cleft palate

Surgery is usually needed to repair a cleft lip or palate.

A cleft lip and/or cleft palate treatment will vary depending on the type of cleft, the health of the child, and the presence of other abnormalities.

Surgery is usually needed to repair a cleft lip or palate. However, surgery cannot be performed right after birth, so your healthcare team will teach you how to feed and take care of your baby in the meantime. This may involve holding your baby in a certain position or using a special bottle to feed them.

Cleft lip surgery

Cleft lip is usually repaired with surgery. This surgery usually takes place around 3 months of age.

Your baby will be placed under general anesthesia, and the surgeon will repair the lip with stitches. Afterward, you and your baby will stay in the hospital for a day or two, for observation. After a few days, these stitches will be removed or dissolve on their own, leaving behind a slight scar. This scar should fade over time and become less noticeable.

Cleft palate surgery

Cleft palate surgery is usually done around 6-12 months of age.

During the surgery, the cleft in the roof of the mouth will be closed. The muscles and mucosa will be rearranged over the newly-closed palate. The surgeon will use dissolvable stitches to close the repaired area. Afterward, a scar will develop inside the baby’s mouth.

Follow-up surgery

Babies who are treated for cleft lip or cleft palate early on usually heal well and may not need additional surgery. However, children with clefting may need certain additional procedures later in life:

  • Ear tube surgery, in which tiny tubes are placed in the eardrum to help fluid drainage and prevent hearing loss.
  • Repair alveolar ridge defect, in which the cleft affects the upper gum and the development of front teeth. This usually involves using a small piece of bone (a bone graft) and implants. This is usually done around 8-12 years of age.
  • Rhinoplasty, or surgery to improve the shape of the nose. This may help with breathing and improve the appearance of the child’s face.
  • Additional surgeries may be needed as a child grows older to improve speech or the appearance of the face.

Many of the treatments available for babies and children are also available for adults with cleft lip and/or palate. This includes treatment for appearance, speech, and dental problems. If you are an adult with a cleft lip or cleft palate, you should talk with your doctor about your needs and concerns.

Additional treatment

Additional treatments may be used alongside surgery to help manage cleft lip and cleft palate symptoms. These may include:

  • Oral hygiene and oral appliances. Children born with cleft palates are more prone to tooth decay and dental problems. They may need more regular visits to the dentist, and they may need braces or other oral adjustments.
  • Speech therapy. A speech and language therapist will assess your speech or child’s speech as they grow. The therapist will work with you or your child to improve speech clarity.
  • Talk therapy or support groups. Children with clefting may experience emotional distress because they feel different from others or because of the intensity of their treatment. This can lead to emotional and behavioral problems. A mental health practitioner can help your child learn how to cope with these feelings. Parents of children with cleft lips may also benefit from therapy or parent-to-parent support groups.

During pregnancy, the tissue that makes up a baby’s jaw and face fuses together to form structures like the mouth and lips. Clefting occurs when these tissues don’t fuse together completely, or at all.

Why some children have cleft lips and others do not is not fully understood. Experts believe clefting has something to do with genetics and environmental factors. One or both parents may pass down genes that cause clefting, or they may pass down genes that make clefting more likely under certain environmental conditions.

Possible risk factors

A risk factor is anything that increases the chance of developing a condition. Risk factors for cleft lip or cleft palate include:

  • Family history and genes: Parents that had a cleft lip or palate are more likely to have kids with the condition. Additionally, if one child has a cleft lip or palate, their sibling is more likely to have a cleft lip or palate.
  • Exposure to certain toxins during pregnancy.
  • Having uncontrolled diabetes during pregnancy.
  • Infection during pregnancy.
  • Taking certain medications, including some anti-seizure and acne medications, during pregnancy.
  • Using alcohol, smoking, or using drugs during pregnancy.

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Sometimes, a cleft lip can develop as part of another medical condition or inherited syndrome, such as stickler syndrome or Pierre-Robin Sequence.

Males are more likely to have a cleft lip without a cleft palate, while females are more likely to have a cleft palate without a cleft lip.

Children born with cleft lip and/ or cleft palate have a higher chance of developing health problems later in life. These problems include:

  • Breathing difficulties through the nose.
  • Difficulty feeding. Babies with cleft lip and especially cleft palate may have difficulty latching on and feeding. A cleft palate can make sucking difficult.
  • Dental problems. If a cleft extends to the upper gums, tooth development may be delayed or affected. People with a cleft palate may also experience alveolar ridge defect, a condition where the bony top part of the gums does not form properly. This can lead to displaced, rotated, or missing permanent teeth, and it usually requires surgery.
  • Ear infections and hearing loss. Having a cleft palate increases the risk of ear infections and having excess fluid in the middle ear. Left untreated, this can lead to hearing loss. Children with cleft palates may need to have specialized tubes placed in their ears to help excess fluid drain.
  • Speech difficulties. The palate is essential to forming sound. Children with a cleft palate may have trouble speaking, or their voices may sound nasal and unclear.
  • Emotional distress and challenges. Children with cleft lip or cleft palate may experience stress and emotional challenges because of the condition. This stress can stem from having so many medical treatments, or it can be related to their appearance.