Cleft Lip and Palate
Cleft lip and palate are birth defects that occur while a baby is developing in the uterus. Between the 6th and 10th weeks of pregnancy, the bones and tissues of a baby's upper jaw, nose, and mouth normally fuse (close) together to form the roof of the mouth and the upper lip. If the tissue in the developing mouth and the palate don't fuse together, a baby could be born with a condition called cleft palate.
The palate is the roof of the mouth and has two main parts. The front part behind the teeth is hard and the back part near the throat is soft. In babies with cleft palate, there is an opening between the roof of the mouth and the nose. This opening may be only through part of the palate (either the soft part or hard part) or through the entire palate. A complete cleft palate occurs when the left and right sides of the roof of the mouth have not fused together in the middle. In many cases, a baby born with a cleft palate also has a cleft lip.
Babies who are born with cleft lip have a gap or opening in the upper lip. A cleft lip can be either unilateral or bilateral. With a unilateral cleft lip, the gap is only on one side of the lip under either the left or right nostril and might extend into the nose. The noses of babies with unilateral cleft lip may look tilted and flat on one side.
Babies born with a bilateral cleft lip have a gap on both sides of the lip, and they may have a deep split in the lip that extends into both nostrils. This may cause the nose to look broader and shorter than normal. In most cases, the cleft occurs only in the upper lip and doesn't affect the lower lip.
A person with a cleft could have only a cleft palate, only a cleft lip, or both a cleft lip and a cleft palate. Cleft lip alone and cleft lip with a cleft palate occurs more often in boys, while cleft palate without a cleft lip occurs more often in girls.
What Causes Cleft Lip and Palate?
Doctors don't know exactly why a baby develops cleft lip or cleft palate, but they believe it may be a combination of genetic and environmental factors. Women with a relative who has a cleft have a slightly higher risk of having a child with a cleft. Both mothers and fathers can pass on a gene or genes that cause cleft palate or cleft lip.
If women take certain medications — such as some medicines to control seizures — during pregnancy, the chance of having a baby with cleft lip or palate may be higher. A mother's exposure to certain chemicals may also cause clefting, although this is rare. Not getting the right nutrients may increase a child's risk of being born with a cleft — for example, if the mother has a lack of folic acid in her diet.
Finally, use of drugs and alcohol during pregnancy increases the risk that a baby will be born with birth defects. Research has shown that moms who binge drink (drinking five or more drinks on one occasion) during the first weeks of pregnancy have a higher risk of having a baby with a facial birth defect such as cleft lip or cleft palate.
Effects of Cleft Lip and Palate
One of the first problems a baby with cleft palate might have is difficulty eating. The palate in a person's mouth prevents food and liquid from going up the nose when swallowing, so a newborn baby with cleft palate may have to be fed breast milk or formula in a bottle with a special nipple. Cleft palate usually makes breastfeeding difficult because the infant has difficulty sucking properly.
People who had cleft palate may also have frequent ear infections as kids. That's because air and fluid can't pass normally through the eustachian tubes, the tubes that connect the throat with the middle ear. This means fluid and germs can become trapped behind the eardrums and cause infection. Some people with cleft palates may have had an operation to put tubes in their ears to help the fluid drain properly. In some cases, people who had cleft palate may have hearing loss because of repeated infections and fluid behind the eardrums.
Dental problems, such as cavities and missing or malformed teeth, also are common in people born with cleft palate.
Speaking clearly can be challenging for kids with cleft cleft palate. Sometimes the soft palate doesn't move well enough to prevent air from leaking out through the nose during speech. This can cause their voices to sound as if they are speaking through their nose. If the teeth don't line up properly, a person may not be able to pronounce certain sounds.
In most children with clefts there are no other physical or learning problems. For some people, cleft palate and cleft lip may be associated with other birth defects, such as heart defects, or other physical problems, such as growth disorders and muscle weakness and some learning difficulty.
What Do Doctors Do?
Because doctors can see cleft lip and palate as soon as a baby is born, they can start working immediately to develop a treatment plan. Usually, a group of medical professionals — called a cleft palate team — works together to fix the problem when a child is very young. A cleft palate team includes some or all of the following specialists:
- a plastic surgeon
- a geneticist (a doctor who specializes in conditions that are inherited)
- an otolaryngologist (a doctor who specializes in conditions of the ears, nose, and throat)
- an oral surgeon
- a dentist
- an orthodontist
- a speech pathologist
- an audiologist (hearing specialist)
- the team coordinator
- a social worker
- psychologist or therapist
Every individual who has been treated for cleft lip or palate has had a different experience. Today, most people born with cleft palate have surgery to close the hole in the roof of the mouth and reconnect the palate muscles between 9 and 18 months of age. This lessens the effects of the cleft palate on their speech development.
People with a complete cleft lip and palate will need several surgeries to repair the cleft. These include cleft lip repair, cleft palate repair, and a bone graft to the upper jaw to close the bone gap in the gum area. In some cases, further surgery may need to be done on the palate or in the throat to improve speech.
People with cleft lip or palate may spend a lot of time at the dentist and orthodontist when they're kids. Hearing tests to check for hearing problems and speech therapy to improve speech skills and patterns are often part of treatment, too.
Although most people have these surgeries during childhood, some may also have plastic surgery during the late teen and young adult years. People who have had cleft lip and palate repair surgery as kids may look flatter in the face. They may have jaws that are not properly aligned and may have difficulty breathing through the nose. Surgery may be required on the jaws and nose to improve the bite, breathing, and facial appearance. Surgery may improve scars from previous operations.
Dealing With Cleft Lip and Palate
Dealing with the physical side of cleft palate can feel difficult enough. But there's also the emotional side: Because cleft lip and palate are something a person's born with and has no control over, it can seem unfair. And because appearance becomes more of a focal point during our teenage years, many people with cleft lip and palate worry about how it might affect their social and emotional lives.
Teens or young adults with cleft lip and palate may have had to cope with bullying or teasing. For many people, this can play havoc with self-esteem. Others find that surviving bullying gives them an inner strength and resourcefulness that others their age may not have developed: Learning to take control over how much you allow physical appearance to affect your life is a skill that people with cleft palate usually develop way before their peers.
If you're a woman and are self-conscious about a cleft lip scar, you may be able to minimize the appearance of the scar with makeup. Guys may be able to grow facial hair to cover their scars because hair growth on the upper lip is not usually affected by previous surgeries.
Your friends, family, and medical team can be a source of support. Talk to them about how you're feeling. You might also want to talk to a counselor or therapist because these health professionals are trained to help people deal with difficult situations and improve self-esteem.
And if you've had cleft lip and palate, you're not alone. Your medical team may be able to put you in touch with other people with cleft lip or palate or support groups in your area. It is important to remember that most kids with cleft lip or palate grow up to be healthy, happy adults!
Reviewed by: Joseph A. Napoli, MD, DDS, and Linda Vallino, PhD, MS, CCC-SLP/A
Date reviewed: February 2007
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