What is Cleft Lip and Cleft Palate?

Cleft lip and cleft palate occur when the lip and/or roof of the mouth (hard and/or soft palate) do not fully develop during pregnancy. Cleft lip and cleft palate are the most common birth defect in the U.S. and can be treated with surgery. 

A cleft lip, what was once called a “hare lip,” is more noticeable than a cleft palate and is distinguished by the “gap” in the upper lip. A cleft palate is hidden inside the mouth and the “gap” is in the hard or soft palate on the roof of the mouth. It is possible to have cleft lip, cleft palate, or both. Just because someone has a cleft lip does not mean they also have a cleft palate and vice versa.

Types of Cleft Lip and Cleft Palate

There are different types of cleft lip and cleft palate based on how the lip and palate have formed during pregnancy. These include:

Types of Cleft Lip

• Unilateral Cleft Lip: A cleft on one side of the lips.
• Bilateral Cleft Lip: A cleft on both sides of the lips.
• Complete: A cleft that goes all the way to the nose.
• Incomplete: A cleft that is only on the lip and does not affect the nose.

Types of Cleft Palate

• Bifid Uvula: A cleft where the uvula (the part of the soft palate that hangs down) has a notch, is forked, or there are two uvula. This cleft often goes unnoticed and is the least severe of the incomplete palate clefts.
• Submucous Cleft Palate: A cleft that is just under the mucous lining of the soft palate. This cleft can go unnoticed until the child learns to speak. This cleft hinders certain movements of speech; therefore, diagnosis may come after a child learns to speak.
• Soft Palate Cleft: A cleft that runs from the uvula through the soft palate and stops where the soft and hard palates meet. This cleft is often diagnosed when a newborn has trouble nursing. The hole in the soft palate make it hard to get a tight seal in the mouth when suckling. In less extreme cases of soft palate cleft, the baby may still be able to nurse effectively. The cleft is diagnosed from the visual “gap” in the soft palate or uvula.
• Soft and Hard Palate Cleft: A cleft that runs through the entire soft palate and any part of the hard palate. The same concerns for nursing exist for soft and hard palate cleft as do for soft palate cleft, and the same speech impediments exist as do for the other cleft palate types.

What Causes Cleft Palate and Cleft Lip?

As with most birth defects, the question, “Is cleft palate/cleft lip genetic?” is often discussed with physicians and pediatricians. Some common causes of cleft palate and lip include:

• Genetics: Cleft palate and cleft lip are genetic but only if one or both of the parents carry the gene that causes cleft palate or cleft lip.
• Environmental Factors: Other factors that can also lead to this birth defect are: 
• Smoking or using drugs while pregnant 
• Viruses or toxins
• Other birth defects

Cleft Lip and Cleft Palate Symptoms

While some cleft lip and cleft palates are noticeable by visually looking at the child, some are not. This is where being aware of other symptoms of cleft lip and palate can assist in diagnosing a baby with this birth defect before speech delays make the defect noticeable.

Common cleft lip and cleft palate symptoms include:

• Difficulty with feeding
• Difficulty swallowing
• Speech issues
• Dental problems
• Chronic ear infections

Cleft Lip and Cleft Palate Diagnosis

Oftentimes, cleft lip and cleft palate are diagnosed before birth via ultrasound. Less noticeable clefts can be diagnosed after birth, visually, or by symptoms from nursing. Clefts that are very subtle, such as submucous clefts, may go undiagnosed until a speech delay occurs. Once a diagnosis occurs, a treatment plan can be put into place.

Treatment for Cleft Lip and Cleft Palate

Sometimes no treatment is required for a small cleft lip or cleft palate if it does not affect a baby from feeding properly or if the cleft is small and on the uvula or submucous clefts.

However, when treatment is needed it is often surgery. A team of specialists is often involved in the treatment of cleft lip and cleft palate and monitoring other areas of the ear, nose and throat that may be affected by a cleft palate or cleft lip.

Specialists that provide treatment for cleft lip and cleft palate include:

• Plastic surgeons or ENTs who specialize in cleft repair
• Oral surgeons
• Pediatricians
• Pediatric dentists
• Orthodontists
• Auditory or hearing specialists
• Speech therapists

Surgery is often recommended for severe clefts that will, or are currently, causing problems with feeding, breathing or will likely cause speech delays or impediments in the future. Most surgeries to repair clefts will be done when the child is 3-9 months old before learning how to speak.

The different types of surgical procedures used to repair a cleft include:

• Cleft lip repair is usually done between 3 and 6 months of age. A surgeon makes an incision on each side of the cleft to create two flaps of skin that are then stitched together to repair the cleft.
• Cleft palate repair is usually done before the child turns 12 months. A surgeon will use various techniques to repair or rebuild the hard and soft palate depending on the severity of the cleft. Then, similar to the lip repair, the two sides of the palate will be stitched together to fully repair the cleft.
• Ear tube surgery may be needed if the cleft interferes with the drainage of fluid from the ears. A build-up of fluid can cause ear infections and in some cases, hearing loss. A tiny tube is inserted into the ear canal to expand the Eustachian tube and allow proper drainage of the fluid.
• Reconstruction surgery usually happens between 2 and 18 years of age. Cosmetic in nature, additional surgeries may be needed to reconstruct the look of the lip as the child grows.