Cleft Lip and Cleft Palate

What is the difference between a cleft lip and cleft palate?

A cleft lip is an opening or 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.

A cleft palate is an opening in the roof of the mouth. A cleft palate can involve only the soft palate (back of the mouth) or both the hard (front of mouth) and the soft palate.

A submucous cleft palate can also occur when the muscles within the soft palate are separated but the skin or mucous membrane is closed. At times the uvula may be bifid, or divided into two parts.

Each year, about 2,500 babies are born with a cleft palate.

With both cleft lip and palate, 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.

What are the different types of cleft lip and cleft palate?

The different types of cleft defects are categorized according to the location of the cleft (unilateral or bilateral) and how much of the lip or palate is involved (incomplete or complete):

• Unilateral defects – the most common type of cleft, affecting one side of the lip, with or without a cleft palate
• Incomplete unilateral cleft lip and/or palate – an opening on one side of the lip that does not extend into the nose, may be accompanied by a cleft palate
   
• Complete unilateral cleft lip and/or palate – an opening on one side of the lip that extends up into the nose and may be accompanied by a cleft palate
  
• Bilateral defects – affecting both sides of the lip and/or palate, forming two clefts
• Incomplete bilateral cleft lip and/or palate – openings on both sides of the lip that do not extend into the nose, may be accompanied by a cleft palate
   
• Complete bilateral cleft lip and/or palate – openings on both sides of the lip that extend up into the nose and may be accompanied by a cleft palate
  
• Children can also have less noticeable form of cleft lip than those depicted above, known as a forme fruste or microform cleft lip. This is a small, subtle indentation on one or both sides of the lip.

What causes cleft lip and cleft palate?

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 lip and cleft palate?

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 lip or cleft palate 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 lip and cleft palate?

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

When do doctors diagnose cleft lip and cleft palate?

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 lip and cleft palate?

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.

The Cleft-Craniofacial Center at UPMC Children's Hospital has a 70-year history of treating children with cleft lip and cleft palate. 

Your care team may consist of doctors and specialists in the following fields:

• Audiology
• Dentistry
• Genetic Counseling
• Neurogenetics
• Neurosurgery
• Ophthalmology
• Oral and Maxillofacial Surgery
• Orthodontics
• Otolaryngology
• Pediatrics
• Plastic Surgery
• Psychiatry and Psychology
• Social Work
• Speech Pathology
• Surgery

The goal of treatment is to make sure that your child can:

• Eat properly
• Speak properly
• Hear normally
• Have a healthy smile
• Have a normal appearance
• Be well adjusted

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

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.