Cleft Palate

What Is a Cleft Palate?

A cleft palate (PAL-it) is when a baby is born with an opening (a cleft) in the roof of the mouth. This leaves a hole between the nose and the mouth.

The opening can:

• just be in the back of the palate (the soft palate)
  or
• extend into the front of the palate behind the gums (the hard palate)

Sometimes the opening in the palate can connect with an opening in the gums and the lip (cleft lip and palate). These orofacial clefts are some of the most common birth defects. Most kids can have surgery to repair them early in life.

A baby with a cleft might have:

• only a cleft palate
• only a cleft lip
• both a cleft lip and a cleft palate

What Causes Cleft Palate?

During the first 6 to 10 weeks of pregnancy, the bones and skin of a baby's upper jaw, nose, and mouth normally come together (fuse) to form the roof of the mouth and the upper lip. A cleft palate happens when parts of the roof of the mouth do not fuse together completely.

Doctors don't always know why a baby develops a cleft, though some clefts may be related to genetic (inherited) factors. Also, some environmental factors can increase the risk of a birth defect, such as:

• taking certain medicines (such as some anti-seizure medicines) during pregnancy
• not getting the right amount of prenatal nutrients, such as folate
• exposure to some chemicals during pregnancy
• smoking cigarettes, using drugs, and/or drinking alcohol during pregnancy

How Is a Cleft Palate Diagnosed?

Newborns have an oral exam soon after they're born. Doctors usually find a cleft palate when they examine the inside of a baby's mouth during this exam. It is difficult to see a cleft palate on a prenatal ultrasound before the baby is born.

How Is a Cleft Palate Treated?

A cleft palate usually is repaired with surgery called palatoplasty (PAL-eh-tuh-plass-tee) when the baby is 10–12 months old. The goals of palatoplasty are to:

• Close the opening between the nose and mouth.
• Help create a palate that works well for speech.
• Prevent food and liquid from leaking out of the nose.

In palate repair surgery, the surgeon will:

• Rearrange and repair the muscles of the soft palate so they work better during speech.
• Close the cleft in layers.

The surgeon may need to make two incisions (cuts) on each side of the palate behind the gums to ease tension on the palate repair. These are called “relaxing incisions.” In some cases, the surgeon may also borrow some tissue from the inner surface of the cheeks to help complete the repair.

Cleft palate repair requires general anesthesia and takes about 2–3 hours. Most babies can go home after 1 or 2 days in the hospital. The stitches will dissolve on their own.

Your child will need a liquid or blenderized (puréed) diet for about 3 weeks after surgery before starting to eat foods that are hard or crunchy. You may be asked to keep your baby in special sleeves ("no-nos") that prevent the elbows from bending. This is so your baby can't put any fingers or hard objects into the mouth, which could make the cleft palate repair come open.

When Should I Call the Doctor?

Cleft palate surgery has greatly improved in recent years. Most kids who undergo it have very good results. There are risks with any surgery, though, so call the doctor if your child:

• has a fever above 101.4°F (38.5°C)
• has lasting pain or discomfort
• has heavy bleeding from the mouth or nose
• won't drink fluids
• isn't making wet diapers

What Else Should I Know?

A child with a cleft palate can sometimes have other health problems, such as:

• trouble breathing
• frequent ear infections
• trouble feeding
• hearing loss
• eye problems
• speech problems

It's important to work with a care team experienced in treating children with cleft lip and palate. Besides the pediatrician, a child's treatment team will include:

• a patient care coordinator
• cleft surgeon (pediatric plastic surgeon or oromaxillofacial surgeon with cleft care experience)
• ear, nose, and throat (ENT) surgeon (otolaryngologist)
• orthodontist
• speech-language pathologist
• audiologist

You might also work with:

• a dentist
• a social worker
• a psychologist or therapist
• a geneticist

Some kids with cleft palate may need other surgeries as they get older. These might include:

• Speech surgery: Children can develop speech problems even after the palate has been repaired. At your regular appointments with the cleft team, the speech-language pathologist will carefully listen to your child's speech to help the surgeon decide if another surgery is needed to improve speech.
• Orthognathic (or-thig-NATH-ik) surgery: Some children with cleft palate need this surgery to realign the jaws and teeth when they're older. It's done when the child is finished growing.

Looking Ahead

Most kids with cleft palate are treated successfully with no lasting problems. A team experienced in treating children with cleft lip and palate can create a treatment plan tailored to your child's needs.

The psychologists and social workers on the treatment team are there for you and your child. Turn to them to help guide you through any hard times. You also can find more information and support online:

• American Cleft Palate-Craniofacial Association (ACPA)
• Cleft Lip & Palate Association
• FACES: The National Craniofacial Association
• Smile Train