CLEFT LIP AND PALATE
A cleft of the lip or palate happens when a baby is born with an opening in the upper lip or the roof of the mouth (the palate). These orofacial clefts are some of the most common birth defects.
A baby with a cleft might have:
• only a cleft palate
• only a cleft lip
• both a cleft lip and 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)
• extend into the front of the palate behind the gums (the hard palate)
Babies who are born with cleft lip have a gap or opening in the upper lip.
This happens when the baby’s lip doesn’t form properly early in pregnancy, resulting in a split.
A cleft lip can be:
• on one side of the lip (a unilateral cleft lip). This type is more common.
• on both sides of the lip (a bilateral cleft lip)
Clefts can range in size:
• Some are just a small notch in the lip (an incomplete cleft lip).
• Others extend from the lip through the upper gum and into the nostril (a complete cleft lip).
If the opening in the palate connects with the opening in the gums and the lip, a baby has cleft lip and palate.
What Causes Cleft Lip and 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 happens when parts of the lip and/or palate do not fuse together completely.
Doctors don’t always know why a baby develops a cleft, though some 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
• exposure to some chemicals during pregnancy
• smoking cigarettes, using drugs, and/or drinking alcohol during pregnancy
How Is a Cleft Lip and Palate Diagnosed?
Usually, clefts are found when a baby is born. Sometimes, they’re seen on a prenatal ultrasound. Without a cleft lip, a cleft palate is harder to see. Doctors usually find a cleft palate when they look and feel inside a baby’s mouth during the first newborn exam.
How Is Cleft Palate With Cleft Lip Treated?
Cleft lip and cleft palate can cause problems with:
• growth and development
• ear infections and hearing
• speech development
So it’s important to correct a cleft palate with cleft lip with surgery while a child is young.
Cleft Lip Repair
A plastic surgeon will repair the baby’s cleft lip first, usually when the baby is about 3 months old.
This is done with a surgery called cheiloplasty (KY-lo-plass-tee). It’s done in the hospital while the baby is under general anesthesia.
The goals of cleft lip repair are to:
• Close the cleft.
• Improve the shape and symmetry of the upper lip and nose.
If the cleft lip is wide, special procedures like lip adhesion or nasal alveolar molding (NAM) might help bring the parts of the lip closer together and improve the shape of the nose before the cleft lip repair. Cleft lip repair usually leaves a small scar under the nose.
Cleft Palate Repair
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, a plastic surgeon will:
• Close the cleft in layers.
• Rearrange and repair the muscles of the soft palate so they work better during speech.
• Make two incisions (cuts) on each side of the palate behind the gums to ease tension on the palate repair.
This surgery 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 diet for a week or two, then will eat soft foods for several more weeks before going back to his or her regular diet. 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.