(Cleft Lip; Cleft Palate)
An oral-facial cleft is a birth defect. A cleft lip is an opening in the upper lip, usually just below the nose. A cleft palate is an opening in the roof of the mouth (hard palate) or in the soft tissue at the back of the mouth (soft palate). In the majority of cases, a cleft lip and cleft palate occur together.
Infant With Cleft Lip
All fetuses have an opening in the lip and palate during early pregnancy. In normal fetal development, these openings close during pregnancy. Failure of one or both of these openings to close results in an oral-facial cleft. The exact cause is not known. Cleft lip occurs alone or in combination with cleft palate in approximately 1 in 750 white births, and cleft palate occurs in approximately 1 in 2,500 white births.
A risk factor is something that increases your chance of getting a disease or condition.
Risk factors for oral-facial clefts include:
For the infant:
- Having other birth defects
- Sex: males
Having a sibling, parent, or other close relative born with an oral-facial cleft
- A geneticist can best define the actual risk, which can vary greatly among families.
- In general, if one child in a family has a cleft palate, the next child has about a 4% chance of also having a cleft palate. If only the lip has a cleft, the risk of this occurring in a second child is about 2%.
For the mother during pregnancy:
- Taking certain drugs, such as antiseizure drugs (especially phenytoin]]> ) or retinoic acid (used for dermatologic conditions, such as ]]>acne]]> )
- Consuming ]]>alcohol]]> (especially in the development of a cleft lip)
- Having an illness or infection
- Having ]]>folic acid]]> deficiency at conception or during early pregnancy
The major symptom of a cleft lip and/or cleft palate is a visible opening in the lip or palate. Other symptoms can occur as a result of an oral-facial cleft include:
- Feeding problems (especially with cleft palate)
- Problems with speech development
- Dental problems, including missing teeth, especially when cleft lip extends to the upper gum area
- Recurrent middle ear infections]]>
- Hearing problems
A doctor can diagnose cleft lip or cleft palate by examining the newborn baby. A newborn with an oral-facial cleft may be referred to a team of medical specialists soon after birth. Rarely, a partial or “submucous” cleft palate may not be diagnosed for several months or even years.
Cleft lip and palate are sometimes associated with other medical conditions. Your doctor should be able to tell you whether or not your child’s clefting is part of a “syndrome.” Some syndromes may require treatment in addition to taking care of a cleft lip or palate.
Prenatal diagnosis (diagnosis prior to birth) can also be accomplished using ultrasound]]> examination. Cleft lip is more easily diagnosed via prenatal ultrasound than cleft palate is. Diagnosis can be made as early as 18 weeks of pregnancy. Prenatal diagnosis gives the parents and the medical team the advantage of advanced planning for the baby’s care.
Treatments may include:
The main treatment is surgery to close the opening in a lip and/or palate. Additional surgical treatment for oral-facial clefts may include:
- Bite alignment surgery if the jaw is not aligned properly
- Plastic and/or nasal surgery to improve facial appearance and function
Other treatments may include:
For cleft palate:
- Prior to surgery, temporary placement of a dental plate in the roof of the mouth to make eating and drinking easier
For middle ear infections and fluid build-up:
- Medications to treat infection or prevent fluid build-up
- Surgery to drain built-up fluid and prevent future infections
Most children with cleft palate are at risk for hearing loss which may interfere with learning language.
- Hearing testing should be done regularly.
- Rarely, children with cleft palate may benefit from hearing aids.
Pregnant women and women who are likely to become pregnant can do the following to help prevent oral-facial clefts in their unborn children:
Consume 400 micrograms of folic acid daily by taking a multivitamin or eating foods containing folic acid, such as:
- Fruits and orange juice
- Green leafy vegetables
- Dried beans and peas
- Pasta, rice, bread, flour, and cereals
- Do not smoke]]> or drink ]]>alcohol]]> during pregnancy.
- Take ]]>medications during pregnancy]]> only as directed by your doctor.
- Get early and regular prenatal care.
If you are thinking about having a child and have risk factors for oral-facial cleft:
- Seek medical advice on additional ways to prevent the disorder.
- Consider ]]>genetic counseling]]> .
Cleft Lip and Palate Association
Cleft Palate Foundation
About Kids Health
Women's Health Matters
Behrman RE, Jensen HB, Nelson WE, Kleigman RM. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, PA: Saunders Elsevier; 2007.
Berkow R. The Merck Manual of Medical Information . New York, NY: Pocket; 2000.
Berkow R, Beers MH, Fletcher AJ. The Merck Manual of Medical Information—Home Edition. 2nd ed. New York, NY: Simon and Schuster, Inc; 2003.
Cleft lip and palate. Medline Plus website. Available at: http://www.nlm.nih.gov/medlineplus/cleftlipandpalate.html . Updated June 2009. Accessed July 9, 2009.
Cummings CW. Cummings: Otolaryngology: Head & Neck Surgery. 4th ed. St. Louis, MO: Mosby; 2005.
Last reviewed September 2009 by ]]>J. Thomas Megerian, MD, PhD, FAAP]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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