A cleft is a cleft or cleft in the upper lip and / or palate. It is present from birth.
The gap is there because parts of the baby’s face didn’t come together properly during development in the womb.
Cleft lip and palate is the most common facial congenital malformation in the UK, affecting about 1 in 700 babies.
What does a cleft lip and palate look like?
Babies can be born with cleft lip, cleft palate, or both.
A cleft lip can affect only one side of the lip or there can be 2 fissures.
It can range from a small notch to a wide opening up to the nose.
A cleft palate can be just an opening at the back of the mouth, or it can be a cleft in the palate that goes all the way to the front of the mouth.
Sometimes it can be hidden by the lining of the palate.
Problems related to cleft lip and palate
A cleft lip and cleft palate can cause a number of problems, especially in the first few months after birth, before surgery is performed.
Possible problems are:
- problems feeding – a baby with cleft lip and palate may not be able to breastfeed or feed from a normal bottle because he cannot form a good seal with his mouth
- hearing problems – some babies with cleft palate are more prone to ear infections and a build-up of fluid in their ears (glue ear), which can affect their hearing
- dental problems – a cleft lip and palate can mean that a child’s teeth are not developing properly and they are at greater risk of tooth decay
- speech problems – if a cleft palate is not repaired, it can lead to speech problems such as slurred or nasal sounding speech when a child is older
Most of these problems will improve after surgery and with treatments such as speech and language therapy.
Causes of cleft lip and palate
Cleft lip or palate occurs when the structures that make up the upper lip or palate don’t come together when a baby is developing in the womb.
The exact reason why this happens in some babies is often unclear. It is very unlikely that it was caused by something you did or did not do during pregnancy.
In a few cases, cleft lip and palate is associated with:
- smoking during pregnancy or drinking alcohol during pregnancy
- obesity in pregnancy
- a folic acid deficiency during pregnancy
- the use of certain medications in early pregnancy, such as certain epilepsy medications and steroid tablets
- the genes that a child inherits from his parents
In some cases, cleft lip or palate can occur as part of a condition that causes a wider range of birth defects, such as 22q11 deletion syndrome (also called DiGeorge or velocardiofacial syndrome) and Pierre Robin sequence.
Diagnosis of cleft lip and palate
A cleft lip is usually picked up during the mid-pregnancy anomaly scan when you are between 18 and 21 weeks pregnant. Not all cleft lips will be evident on this scan, and it is very difficult to detect cleft palate on an ultrasound.
If a cleft lip or palate does not show up on the scan, it is usually diagnosed immediately after birth or during the newborn’s physical exam done within 72 hours of birth.
When a cleft lip or palate is diagnosed, you will be referred to a specialized NHS cleft team who will explain your child’s condition, discuss the treatments they need, and answer any questions.
It may also be helpful to reach out to a support group, such as the Cleft Lip and Palate Association, who can provide advice and connect you with parents in a similar situation.
Treatments for cleft lip and palate
Cleft lip and cleft palate are treated in specialized NHS cleft centers.
Your child will usually have a long-term care plan outlining the treatments and assessments they will need as they get older.
The main treatments are:
- surgery – surgery to correct cleft lip is usually done when your baby is 3 to 6 months old and surgery to repair cleft palate is usually done after 6 to 12 months
- feeding support – you may need advice on positioning your baby on your breast to help feed him, or you may need to feed him with a special type of bottle
- hearing monitoring – a baby born with a cleft palate is more likely to have a glue ear, which can affect hearing. Closely monitoring their hearing is important and if the glue ear is significantly affecting their hearing, a hearing aid can be fitted or small tubes, grommets, can be placed in their ears to drain the fluid
- speech and language therapy – a speech and language therapist monitors your child’s speech and language development during childhood and helps with any speech and language problems
- good oral hygiene and orthodontic treatment – you will be advised on how to take care of your child’s teeth, and may need braces if the adult teeth are not coming through properly
Outlook for cleft lip and palate
The majority of children treated for cleft lip or palate grow up to live completely normal lives.
Most affected children will not have other serious medical problems, and treatment can usually improve the appearance of the face and problems with eating and speaking.
Surgery to fix a cleft lip can leave a small pink scar above the lips. This will fade over time and become less noticeable as your child gets older.
Some adults who have had a cleft lip or cleft palate may be self-conscious or unhappy about their appearance. Your primary care physician can refer you back to an NHS cleft center for further treatment and support if there are any problems.
Will there be cleft lip and palate again?
Most cases of cleft lip or palate are one-time, and you are unlikely to have another child with the condition.
The risk of having a child with cleft lip or palate is slightly increased if you’ve had a child with the condition before, but the chance of this happening is estimated to be about 2 to 8%.
If you or your partner were born with a cleft lip or palate, your chances of having a baby with cleft lip are also about 2 to 8%.
The chances that another child will be born with a cleft or that a parent will pass the condition on to their child may be higher in cases related to a genetic condition.
For example, a parent with 22q11 deletion syndrome (DiGeorge syndrome) has a 1 in 2 chance of passing the condition on to their child.
SOURCE: NHS