Cleft Lip and Palate

Signs and Symptoms

A cleft lip and palate is noted at birth by the presence of a gap or cleft in the upper lip either on one or both sides of the lip together with a cleft in the palate (the roof of the mouth). A cleft palate can either be open and obvious or be covered over by the lining or mucous membrane of the roof of the mouth, called a submucous cleft, which is not visible to the naked eye.

An infant with cleft lip and palate usually needs to be bottle-fed (either breast milk or formula) using special nipples.

Diagnosis

Cleft lip and palate is diagnosed by physical examination at birth, although high-resolution ultrasound may reveal the presence of a cleft lip in the womb. That said, a cleft palate usually is not detectable on ultrasound.

A genetic evaluation can determine if the cleft is an isolated condition or part of another syndrome or condition. A cleft lip and palate should be diagnosed and treated by an experienced team of experts recognized by the American Cleft Palate-Craniofacial Association, like the Center for Craniofacial Anomalies at UCSF.

Treatment

Surgery is necessary to repair a cleft lip and palate, and this intervention is considered reconstructive and not cosmetic.

Treatment of a cleft lip and palate occurs in stages determined by the child's growth and development. Soon after birth and in preparation for surgery, the lip may need to be taped to help reduce the width of the cleft.

Since ear infections are more common for a child with a cleft palate, a hearing test is recommended to determine whether ventilating tubes, which reduce the risk of ear infections, should be placed in the ears at the time of palate surgery. In addition, an eye examination usually is recommended because associated eye anomalies are not uncommon.

The lip cleft usually is repaired when the infant is around 10 weeks old (or at 10 pounds). Surgery takes two to three hours and often requires the infant to remain in the hospital one night. If needed, a revision of the lip repair will occur before the child begins school.

The cleft palate tends to be repaired when the infant is around 8 to 10 months old or when he or she is starting to make sounds of speech. Palate surgery often takes about two or three hours, with the infant staying in the hospital one or two nights. Although a child's speech usually is normal after cleft palate repair, in some cases, speech therapy or a second palate surgery may be needed. A submucous cleft palate is only repaired surgically if it is determined that the procedure would improve speech difficulties.

Orthodontic treatment (braces) and alveolar bone grafting to fill the remaining gap in the gum line often are necessary. The first phase of treatment usually includes the widening of the upper jaw with an orthodontic appliance and occurs once the permanent front teeth have come in, when the child is around 7 years old. Bone grafting surgery is done after the widening is completed. Orthodontic treatment continues until all teeth are aligned.

A child with a cleft lip and palate may encounter social and emotional challenges unique to this condition. Support organizations and resources are available for children and their families.