Cleft lip and cleft palate (cheiloschisis and palatoschisis) is the incomplete formation of the upper lip (cleft lip) or roof of the mouth (cleft palate). They may occur alone or in combination with each other and may be unilateral or bilateral.
Facial formation occurs early on during gestation and involves specified cells from both sides of the head multiplying and growing towards the center of the face until they finally merge together. The merging of this tissue shapes the features of the face, such as the mouth and lips. If this process is interrupted during development, ‘orofacial’ birth defects, such as a cleft lip and cleft palate may occur.
What is a Cleft Lip and Cleft Palate?
Cleft lip and cleft palate are types of orofacial clefts, which are characterized by splits or openings in the upper lip, gum line, and roof of the mouth. When evolving facial structures in a baby do not fully close during pregnancy, a cleft lip, cleft palate, or both may occur. Among the most frequently seen birth defects in children, cleft lip and cleft palate most often occur as solitary issues. However, they can be related to a number of hereditary syndromes and conditions, as well. Although having a baby with one or both of these problems can be very unexpected, normally a cleft lip and cleft palate can be surgically corrected.
Signs and Symptoms of Cleft Lip and Cleft Palate
A cleft, which is a split in the palate or lip, is typically observable immediately upon the birth of a new baby. Cleft lip and cleft palate usually present as:
- A split in the lip and palate (roof of the mouth) that may impact just one or both sides of the face
- A split in the lip that looks like a little notch (microform cleft lip)
- A split in the lip carried from the lip, through the upper gum and palate, all the way into the bottom of the nose
- A split in the palate (roof of the mouth) not visualized externally
Submucous Cleft Palate
A less frequent abnormality, termed a submucous cleft, is found only in the muscles of the soft palate and is not typically distinguished at birth. This type of split occurs in the back of the mouth and is concealed by the mouth’s lining. Consequently, a submucous cleft of the palate may go undiagnosed until the following signs and symptoms begin to present themselves:
- Frequent ear infections
- Swallowing problems
- Nasal toned speaking voice
What Causes a Cleft Lip and Cleft Palate?
The exact causes of a cleft lip and cleft palate in babies are not fully understood. According to the Centers for Disease Control and Prevention (CDC), some children develop a cleft lip and cleft palate due to a genetic alteration. Generally, orofacial clefts are believed to result from an amalgam of genetics and environmental factors. For instance, an unborn baby may develop a cleft lip and cleft palate due to some combination of changes in genes, as well as exposures in the in utero environment.
Risk Factors for Cleft Lip and Cleft Palate
The CDC has recently released some important research findings regarding risk factors related to having an infant with an orofacial cleft. The following risk factors have been found to increase the chance of a mother giving birth to a child with a cleft lip, cleft palate, or both:
- Diabetes—Women who have been diagnosed with diabetes before pregnancy (not gestational diabetes) have an increased risk of having a baby with cleft lip accompanied or unaccompanied by a cleft palate.
- Certain medication use—There are certain medications, such as those to treat epilepsy (like topiramate or valproic acid), that if taken during the first trimester of pregnancy (first 3 months) increase the risk for having a baby with a cleft lip accompanied or unaccompanied by a cleft palate.
- Smoking—Women who choose to smoke while pregnant have an increased risk of giving birth to a baby with a cleft lip and a cleft palate.
How are Cleft Lip and Cleft Palate Diagnosed?
Typically, cleft lip and cleft palate are birth defects that are recognizable and diagnosable upon the birth of an infant. In most cases, no specific tests are needed for diagnosis. In fact, cleft lip and cleft palate increasingly are being diagnosed by ultrasound imaging during pregnancy. Ultrasound technology uses sound waves to generate pictures of an unborn baby. Upon evaluation of these images, a physician may be able to discern this irregularity in the baby’s facial features as early as the 18th week of pregnancy. If a cleft is detected during a fetal ultrasound, the physician may want to perform a procedure to draw a sample of amniotic fluid from the uterus (amniocentesis), in order to detect any other abnormalities, such as any hereditary genetic syndromes. Most cases of cleft lip and cleft palate do, however, occur as isolated abnormalities.
Surgical Treatment for Cleft Lip and Cleft Palate
The hope and goal of treating a cleft lip and cleft palate is for a child to effectively speak, hear, eat, breathe, and to acquire an aesthetically normal facial appearance. Treatment for a cleft lip and cleft palate requires surgery to correct the defect and specific therapies to ameliorate any associated conditions. The type and amount of surgeries a child will need depends on each individual situation. After the initial repair of the cleft, the physician may suggest additional procedures to enhance the appearance of the lip and nose, as well as to improve the child’s speech. Usually, surgeries are carried out in the order described below:
- Cleft lip repair—Between the ages of 1 and 4 months, a surgeon will close the split in the lip by first creating flaps of tissue on each side of the cleft and then suturing them together. This procedure should produce a more normal appearance of the lip, function, and structure.
- Cleft palate repair—Between the ages of 5 and 15 months, a surgeon will close the split of the hard and soft palate of the mouth and rebuild this area, depending on each specific situation. Multiple procedures are used to accomplish the restructuring of the hard and soft palate, but ultimately the surgeon will make cuts on each side of the cleft, reposition the muscles and the tissue, and then suture the repair.
Cleft Lip and Palate Time Continuum
Follow-up procedures between 2 years of age and anywhere in the late teen years may be advised and/or necessary to prevent any related complications, help the child live as normally as possible, increase the health of the child, and enhance the appearance of the child. For children with a cleft palate, ear tubes are often needed to lessen the risk of recurrent ear infections, which can cause eventual hearing loss. Additional procedures may be required to improve the child’s appearance, related to their mouth, nose, and lip.
In general, surgical treatment for cleft lip and cleft palate can significantly enhance a child’s quality of life, appearance, and capacity to talk, eat, and breathe normally.
Psychological aspects of cleft lip and palate can be one of the greatest concerns for the parents of our patients with these facial anomalies. A patient affected by these facial differences not only has to undergo cleft lip and cleft palate surgery and often years of medical treatment, but possible social challenges that can have long-term effects on self-esteem and his/her ability to successfully interact in social settings.
Psychological Aspects Of Cleft Lip And Palate
- Psychosocial Concerns and Social Stigma of Cleft Lips and Cleft Palates
- Building Self-Esteem and Coping Strategies in a Child with Cleft Lip and Palate
- Preparing Your Cleft Lip and Palate Affected Child for Social Interaction
- Psychosocial Challenges of Adolescents and Teens with Cleft Lip and Palate
Our special care for children meets the ACPA national standards established by the American Cleft Palate – Craniofacial Association and is committed to team care. This includes prenatal consultations, feeding therapies, support in the growth and development of each child, coordinating care and procedures with your child’s primary care provider and other specialists. Whether a child’s orofacial cleft is isolated or associated with other genetic conditions, we specialize in the needs of each individual by providing a team of providers who will care for your child as a whole person from birth to adulthood.
If you would like more information about this craniofacial anomaly, please contact the Craniofacial Team of Texas by calling 512-377-1142 or toll free 877-612-7069 to schedule an appointment or complete an online appointment request.