Cleft Lip and Palate

Oral-facial clefts are birth defects in which the tissues of the mouth or lip don't form properly during fetal development. In the United States, clefts occur in 1 in 700 to 1,000 births, making it the one of the most common major birth defects. Clefts occur more often in children of Asian, Latino, or Native American descent.

The good news is that both cleft lip and cleft palate are treatable birth defects. Most kids who are born with these conditions can have reconstructive surgery within the first 12 to 18 months of life to correct the defect and significantly improve facial appearance.

What Is Oral Clefting?

Oral clefting occurs when the tissues of the lip and/or palate of a fetus don't grow together early in pregnancy. Children with clefts often don't have enough tissue in their mouths, and the tissue they do have isn't fused together properly to form the roof of their mouths.

A cleft lip appears as a narrow opening or gap in the skin of the upper lip that extends all the way to the base of the nose. A cleft palate is an opening between the roof of the mouth and the nasal cavity. Some children have clefts that extend through both the front and rear part of the palates, while others have only partial clefting.

There are generally three different kinds of clefts:

• cleft lip without a cleft palate
• cleft palate without a cleft lip
• cleft lip and cleft palate together

In addition, clefts can occur on one side of the mouth (unilateral clefting) or on both sides of the mouth (bilateral clefting).

More boys than girls have a cleft lip, while more girls have cleft palate without a cleft lip.

Because clefting causes specific visible symptoms, it's easy to diagnose. It can be detected through a prenatal ultrasound. If the clefting has not been detected prior to the baby's birth, it's identified immediately afterward.

What Causes Oral Clefting?

Doctors don't know exactly why a baby develops cleft lip or cleft palate, but believe it may be a combination of genetic (inherited) and environmental factors (such as certain drugs, illnesses, and the use of alcohol or tobacco while a woman is pregnant). The risk may be higher for kids whose sibling or parents have a cleft or who have a history of clefting in their families. Both mothers and fathers can pass on a gene or genes that cause cleft palate or cleft lip.

Complications Related to Oral Clefting

A child with a cleft lip or palate tends to be more susceptible to colds, hearing loss, and speech defects. Dental problems - such as missing, extra, malformed, or displaced teeth, and cavities - also are common in children born with cleft palate.

Many children with clefts are especially vulnerable to ear infections because their eustachian tubes don't drain fluid properly from the middle ear into the throat. Fluid accumulates, pressure builds in the ears, and infection may set in. For this reason, a child with cleft lip or palate may have special tubes surgically inserted into his or her ears at the time of the first reconstructive surgery.

Feeding can be another complication for an infant with a cleft lip or palate. A cleft lip can make it more difficult for a child to suck on a nipple, while a cleft palate may cause formula or breast milk to be accidentally taken up into the nasal cavity. Special nipples and other devices can help make feeding easier; you will probably be given information on how to use them and where to buy them before you take your baby home from the hospital. And in some cases, a child with a cleft lip or palate may need to wear a prosthetic palate called an obturator to help him or her eat properly.