Cleft lip and palate

A cleft lip and palate is a congenital condition, in which part of a baby's mouth is not joined up during fetal development, resulting in a split or open space (cleft) in the lip or palate. The palate is the roof of the mouth, with the bony hard palate at the front of the mouth and the muscular soft palate at the back. While they can occur separately, it is not uncommon for both cleft lip and cleft palate to occur at the same time. Cleft palate occurs 1 in every 2500 births, and about 1 in 800 births are affected by cleft lip and/or cleft palate.

Cleft lip appears as a split in the lip and cleft palate appears as a split in the roof of the mouth. Unlike cleft lip, cleft palate does not affect outward appearance, but still requires corrective surgery. Sometimes babies can be born with both a cleft lip and palate.

Unilateral clefts occur on one side of the face and bilateral clefts occur on both sides. Clefts can also be submucous clefts, occurring in either the hard or soft palate; these clefts can go unnoticed for some time because they are covered by a layer of mucosal tissue.

Different types of cleft lip and palate. 

Causes

The causes of cleft lip and palate are unknown. In some cases it is hereditary, with parents who had a cleft lip or palate carrying a small chance of passing it onto their child, but most cases appear spontaneously. Smoking tobacco and drinking alcohol have been implicated as potential contributors, but the evidence is unclear. A deficiency in folic acid (folate) during pregnancy may also contribute to cleft lip and palate. Certain medications, including some used to treat epilepsy, have also been implicated.

Methods for diagnosis

Sometimes cleft lip and palate is noticed before birth during ultrasound, but the sensitivity of the scan is low so it is commonly only noticed after birth during physical examination of the newborn.

Types of treatment

Surgery

Various surgical techniques are used to correct cleft lip and palate. However, there is no consensus about the timing, technique, or protocol of the repair. Surgery for cleft lip is usually performed at around 3-6 months of age and cleft palate at 9-12 months of age. Cosmetic procedures may also be necessary as the child matures.

Surgery can be used to correct a cleft lip and palate. 

Potential complications

Surgery

Complications arising from surgery include:

• Scarring of the lip;
• Fistula - this is a small hole that can remain in the palate that connects the mouth to the nose. This can lead to food entering the nose and a nasal tone to speech, and;
• Vermilion notching - the vermilion border is the point separating the lip and the skin around it. Vermilion notching occurs when surgery does not achieve a full smooth vermilion.

Cleft lip and palate

Complications of cleft lip and palate include:

• Feeding difficulty - babies with a cleft lip are often able to nurse, but babies with a cleft palate are not because the roof of the mouth being open causes a loss of suction;
• Dental problems - abnormalities can result in teeth not developing properly, in which case dental treatment may be required;
• Ear infections and hearing loss - ear infections can occur due to the dysfunction of the tube connecting the throat and middle ear. Recurrent infections can result in hearing loss, and;
• Speech and language problems - the opening in the roof of the mouth can affect muscle function, causing delayed or abnormal speech, which may require speech therapy.

Prognosis

If your child has cleft lip and palate, the good news is surgery can restore normal function and often results in a greatly improved cosmetic appearance.

Prevention

Cleft lip and palate cannot be prevented. There is some evidence that avoiding alcohol and tobacco may reduce the risk of these birth defects. Taking folic acid may also reduce the risk, but the evidence is unclear. Speak to your doctor before you get pregnant, if you are taking medication for epilepsy or other conditions, to ensure they are safe during pregnancy.