Cleft Lip and Cleft Palate

What  Are Cleft Lips and Cleft Palates?

Cleft lips and cleft palates are splits, or openings, in the mouth and face. They're both congenital conditions, meaning babies are born with them. They're also sometimes called "isolated conditions" because a child can have either condition and be otherwise healthy.

If your baby has a cleft lip or cleft palate, they may have trouble eating. If left untreated, they may also have issues later on with speaking and with their teeth.

Contact Us

Meet our team at UPMC Children's Hospital of Pittsburgh's Cleft-Craniofacial Center and learn about our treatment options, or contact UPMC Children's Hospital of Pittsburgh at 412-692-5325.

Overview

What is the difference between cleft lips and cleft palates?

A cleft lip is an opening in the upper lip; a cleft palate is an opening in the roof of the mouth. In both cases, an opening forms because the facial structure doesn't close completely during development. A child can be born with one or both of these conditions.

Cleft lips

A cleft lip is a split in the upper lip. A baby can have a cleft on one side or both sides of their lip. A cleft lip can also extend up into the nose. Nearly 4,500 children are born each year with the condition, making it one of the most common congenital abnormalities.

Types of cleft lip

There are five types of cleft lip. These are:

  • Forme fruste or microform  cleft lip: A small indentation on one or both sides of the lip
  • Incomplete unilateral cleft lip: An opening on one side of the lip that does not extend into the nose
  • Complete unilateral cleft lip: An opening on one side of the lip that extends up into the nose and typically involves the gum ridge and palate
  • Incomplete bilateral cleft lip: Openings on both sides of the lip that do not extend into the nose
  • Complete bilateral cleft lip: Openings on both sides of the lip that extend up into the nose and typically involve the gum ridge and palate

Cleft palates

A cleft palate is a split in the roof of the mouth. Each year, about 2,500 babies are born with this condition.

Types of cleft palate

There are three types of cleft palate. These are:

  • Incomplete cleft palate: Opening in the back of the mouth, called the soft palate
  • Complete cleft palate: Opening in the front and back of the mouth, or the soft and hard palates
  • Submucous cleft palate: Muscles within the soft palate are separated or cleft but the skin or mucous membrane is closed.  At times the uvula may be bifid

What causes cleft lips and cleft palates?

Both of these conditions form during early pregnancy. Experts aren't sure what causes them, but the conditions could develop if:

  • There are changes in the baby's genes
  • The mother has a disease, such as diabetes
  • The mother uses certain drugs for epilepsy in early pregnancy
  • The mother smokes or drinks alcohol in early pregnancy

Who is at risk for cleft lips and cleft palates?

Risk Factors

Both non-preventable factors, such as family history, and lifestyle risks, such as smoking, can increase your chance of having a child with cleft lip or cleft palate. You may be more likely to have a baby with one or both of these conditions if:

  • A family member has one of these conditions
  • The mother is diabetic
  • The mother smoked or drank alcohol in early pregnancy
  • The mother used certain medicines in early pregnancy

Complications

Babies with cleft lips or cleft palates may struggle to feed because they can't suck or swallow properly. As the child grows, they may have problems with:

  • Hearing
  • Teeth development
  • Speech
  • Social development

Can you prevent cleft lips and cleft palates?

If you're planning to become pregnant, you may be able to reduce the chance of having a child with these conditions by:

  • Taking prenatal vitamins
  • Avoiding alcohol
  • Avoiding smoking
  • Talking to your doctor about medicines you're taking
  • Making sure you're as healthy as possible before becoming pregnant

Symptoms & Diagnosis

Cleft Lip and Cleft Palate Symptoms and Diagnosis

When do doctors diagnose cleft lips and cleft palates?

Many babies with cleft lip or cleft palate are diagnosed before birth, during ultrasound exams, though it's easier to see a cleft lip than a cleft palate on an ultrasound scan.

If your doctor thinks your baby may have one of these conditions, you may need more tests.

The UPMC Children’s Hospital of Pittsburgh Cleft Craniofacial Center is available to provide prenatal consultations if a cleft or craniofacial condition is diagnosed during pregnancy.  This consultation will allow the family to meet the care team and allow our specialists determine if further testing is required.

Your doctor may offer to perform an amniocentesis to see if there's a genetic cause for the cleft lip and/or palate and to determine if your baby has any other health problems.

If these conditions aren't diagnosed during pregnancy, the doctor who examines your baby at birth will probably find them. A submucous cleft palate is hardest to detect since the cleft is hidden by the mouth's lining.

What are the symptoms of cleft lips and cleft palates?

The symptoms of both conditions include feeding difficulties, such as not being able to suck. Children with cleft palate may also have problems with swallowing and food coming out of their nose.

Treatment

Cleft Lip and Cleft Palate Treatment Options

The Cleft-Craniofacial Center at Children's Hospital of Pittsburgh has a 70-year history of treating children with cleft lips and cleft palates. 

Your care team may consist of:

  • A plastic surgeon
  • A Pediatric dentist
  • An Oralmaxillofacial surgeon
  • An ear, nose, and throat (ENT) specialist
  • A speech pathologist
  • A hearing specialist (audiologist)
  • A Psychologist
  • A Social Worker
  • A Orthodontist
  • A Geneticist

The goal of treatment is to make sure that your child can eat properly, speak properly, hear normally, have a healthy smile, normal appearance and to be well adjusted.

Because your child may have trouble feeding, a member of our team will give you special instructions on how best to feed your baby. Feeding a baby with one of these conditions can be stressful and requires patience and the use of special bottles or nursers.

Surgery for cleft lips and cleft palates

Most children with cleft lip or cleft palate require surgery, but it probably won't happen right away. Cleft lips are usually treated between three and six months of age; cleft palates are often treated a little later, usually between nine and 18 months of age. The doctor may put tubes in the baby's ears during one of  these surgeries to help prevent ear infections.

Most babies with cleft lip and palate need more than one surgery, but the doctors may not know until after the first surgery is done.

If your baby's cleft lip includes a cleft in the gum, the lip may be repaired first and the gum repaired after several more years. The lip is repaired earlier to normalize appearance.  Gum openings are typically not repaired until 7 – 10 years of age.

Other treatment for cleft lips and cleft palates

Before your child has surgery, it's important that they get the nutrition they need for normal development. Your baby may need special bottles or even a feeding tube to help them feed normally.

Some babies may benefit from nasoalveolar molding. This process uses plastic plates to help reshape the palate, nose, gums, and/or lip before surgery and can help reduce the number of surgeries your child might need.

Our team can also provide information about a special kind of tape that can temporarily close a lip cleft.

Prognosis

Children with a cleft palate or cleft lip need follow-up for many years, as some problems aren't noticeable until they're older. Most children who have surgery attain a normal appearance and are able to speak and eat normally.