A “cleft” means a split or separation. A cleft palate refers to the roof of your mouth with or without the lip being split as well. Oral clefts are one of the most common birth defects. A child can be born with both a cleft lip and cleft palate, or a cleft in just one area. During normal fetal development between the sixth and eleventh week of pregnancy, the two sides of the lip and palate fuse together. In babies born with cleft lip or cleft palate, one or both of these splits fail to come together.
There are three primary types of clefts. Cleft lip/palate is when both the palate and lip are cleft, which represents about 50 percent of all clefts. About one in 1,000 babies are born with cleft lip/palate. Up to 13 percent of cases involve other birth defects, and occur more often in male children. It is more common in Asian populations and certain groups of American Indians, but less common in African American populations.
Isolated cleft palate is the term used when a cleft occurs only in the palate. About one in 2,000 babies are born with this type of cleft (the incidence of submucous cleft palate, a type of isolated cleft palate, is one in 1,200). This represents about 30 percent of all clefts. All ethnic groups have similar risk for this type of cleft, but it occurs more often in female children.
Isolated cleft lip refers to a cleft in the lip only accounting for 20 percent of all clefts.
Symptoms of cleft lip/palate include:
No one knows exactly what causes clefts, but most believe they are caused by one or more of three main factors: (1) an inherited characteristic (gene) from one or both parents; (2) poor early pregnancy health or exposure to toxins such as alcohol or cocaine; and/or (3) genetic syndromes. A syndrome is an abnormality in genes or chromosomes that result in multiple malformations in a recognizable pattern occurring together.
Cleft lip/palate is a part of more than 400 syndromes including Waardenburg, Pierre Robin, and Down syndromes. Approximately 30 percent of cleft deformities are associated with a syndrome, so a thorough medical evaluation and genetic counseling is recommended for cleft patients.
Clefting of the lip and palate is usually visible during the baby’s first examination. One exception is a submucous cleft where there are abnormalities in the hard or soft palate that remain covered by a smooth, unbroken lining of the mouth. A child with cleft lip or palate is often referred to a multidisciplinary team of experts for treatment. The team may include: an ENT (ear, nose, and throat) specialist (or otolaryngologist), plastic surgeon, oral surgeon, speech pathologist, pediatric dentist, orthodontist, audiologist, geneticist, pediatrician, nutritionist, and psychologist/social worker.
The complications of cleft lip and cleft palate can vary greatly depending on the degree and location of the cleft. They can include some or all the following:
Treatment of clefts is highly individual, depending on the overall health of the child and the severity and location of the cleft(s). Multiple surgeries and long-term follow up are often necessary. Because clefts can interfere with physical, language, and psychological development, treatment is recommended as early as possible.
Surgery to repair a cleft lip is usually done between 10- and 12-weeks-old. The cleft palate repair procedure, called “palatoplasy,” is done between nine and 18 months. Additional surgeries are often needed to achieve the best results. In addition to surgery, the child may receive follow-up care from members of the multidisciplinary team for speech, dental, or other developmental issues.
With permission of the American Academy of Otolaryngology–Head and Neck Surgery Foundation,
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