One of the most common birth defects in the U.S. is a cleft lip and palate. A cleft is an opening or split. The palate is the roof of the mouth. So a cleft lip and palate is a split or divide in the lip or the roof of the mouth or both. About one in 700 infants are born with this condition in the U.S. each year.
Everyone starts life with both a cleft lip and a cleft palate. Between the 6th and 11th weeks of pregnancy, both these clefts normally fuse closed. In some cases, either the lip or the palate or both fail to heal closed, causing the cleft we see when the child is born. A cleft lip can range from a tiny notch in the upper lip to a split that extends through the lip and into the nose. Usually, a cleft lip or palate is immediately identified at birth. A less common type of cleft palate, known as a submucous cleft, is a split at the back of the mouth that is covered by the lining of the mouth. Because the split is not clearly visible, it may not be diagnosed until later.
Complications a cleft lip or palate
The first impact of a cleft lip or palate in a newborn baby is the cosmetic appearance. But there are also several serious medical concerns for babies with clefts:
• Breathing – Malformations of the palate and jaw can make breathing difficult. In some cleft palates, the inside of the nose is open to the mouth, which allows fluids to pass between the nose and mouth.
• Feeding – An infant with a cleft lip may have trouble feeding. The cleft may cause inadequate suction, lack of an air-tight latch, or problems with fluids getting into the nose and causing difficulties with breathing. Special nipples and feeding appliances that help close the hole can help, as can more frequent burping.
• Ear infections – Babies with cleft palates may be more prone to get inner ear infections. Over time, these can cause permanent hearing damage. So it’s important to have your child regularly evaluated by an audiologist or an Ear, Nose and Throat doctor. Ear tubes can help reduce the buildup of fluid in the middle ear and restore hearing.
• Speech and language delays – Children born with a cleft lip or palate may experience delays in the development of sounds and speech. A normal lip and palate are necessary for clear speech. Surgery to repair the cleft and speech therapy can help with speech and language development.
• Dental problems – A cleft palate can also affect the formation of the jaw and gums, which affects the proper growth of the teeth.
Risk factors for cleft lip and palate
Medical professionals have not isolated the cause of cleft lip and palate, but there are several factors that may be involved:
• Genetic factors – Either parent can pass a gene along to the baby that causes cleft lip and palate. Some genes only cause the cleft. Others may be part of a syndrome or set of symptoms such as Down, Waardenburg, or Pierre Robin syndromes.
• Environmental factors – Some clefts may be caused by poor nutrition in the mother during pregnancy, particularly a lack of folate in the diet. Smoking, drinking alcohol, and taking certain prescription and recreational drugs while pregnant have also been linked to the development of cleft lip and palate in the baby.
• Family history – A baby is more likely to be born with a cleft if other members of the family have them. Cleft lip is more likely to be inherited than cleft palate.
• Race – Black children are least likely to have a cleft. American Indian, Hispanic, and Asian children are more likely to be born with a cleft.
• Sex – Boys are twice as likely to have a cleft lip. Girls are twice as likely to have a cleft palate.
Treatment for cleft lip and palate
Surgery to repair a cleft lip is usually scheduled within the first 3 months after a child is born. Surgery to repair a cleft palate is usually performed before the child is a year old. Follow-up surgeries may be needed to improve speech, or improve the appearance of the lip and nose. The child may also benefit from speech and psychological therapies to complete the healing process.
Sources:
American Academy of Otolaryngology – Head and Neck Surgery
Mayo Clinic