A cleft is a gap or tear in the upper lip and / or roof of the mouth (palate). It is present from birth.
The gap is there because parts of the baby’s face did not fit together properly during development in the womb.
A cleft lip and palate are the most common birth defects in the face in the UK, occurring in about 1 in every 700 babies.
What does a cleft lip and palate look like?
Babies can be born with a cleft lip, a cleft palate or both.
A cleft lip can affect only one side of the lip, or there can be two clefts.
It can range from a small notch to a wide gap that reaches the nose.
A cleft palate may be just an opening at the back of the mouth, or it may be a tear in the palate that extends to the front of the mouth.
Sometimes it can be hidden by the lining of the mouthpiece.
Problems with 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 the surgery is done.
Problems may include:
- struggling to feed – a baby with a cleft lip and palate may not be able to breastfeed or feed from a normal bottle because they cannot form a good seal with their mouth
- hearing problems – some babies with a cleft palate are more vulnerable to ear infections and an accumulation of fluid in their ears (gum), which can affect their hearing
- dental problems – a cleft lip and palate can mean that a child’s teeth do not develop correctly and that they have a higher risk of tooth decay
- speech problems – if a cleft palate is not repaired, it can lead to speech problems such as indistinct or nasal sound 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
A cleft lip or palate occurs when the structures that make up the upper lip or palate do not join together when a baby develops 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 some cases, cleft lip and palate are associated with:
- smoking during pregnancy or drinking alcohol during pregnancy
- obesity during pregnancy
- a lack of folic acid during pregnancy
- take certain medications in early pregnancy, such as medication for seizures and steroid tablets
- the genes that a child inherits from their parents
In some cases, a cleft lip or palate may occur as part of a condition that causes a wider range of congenital disorders, such as 22q11 deletion syndrome (sometimes called DiGeorge or velocardiofacial syndrome) and Pierre Robin sequence.
Diagnosis of cleft lip and palate
A cleft lip is usually picked up during the anomaly scan in mid-pregnancy when you are between 18 and 21 weeks pregnant. Not all cleft lips will be clear during this scan, and it is very difficult to detect a cleft palate during an ultrasound scan.
If a cleft lip or palate does not appear at the scan, it is usually diagnosed immediately after birth or during the newborn physical examination done within 72 hours after birth.
When a cleft lip or palate is diagnosed, you will be referred to a specialist NHS cleft team who will explain your child’s condition, discuss the treatments they need, and answer any questions you may have.
You may also find it helpful to contact a support group, such as the Cleft Lip and Palate Association, who can provide advice and put you in touch with parents in a similar situation.
Split lip and palate treatments
Split lip and cleft palate are treated at specialist NHS cleft centers.
Your child usually has a long-term care plan that sets out the treatments and assessments they will need when they grow up.
The most important treatments are:
- surgery – an operation to correct a cleft lip is usually done when your baby is 3 to 6 months old and an operation to repair a cleft palate is usually done at 6 to 12 months
- nutritional support – you may need advice on the position of your baby on your breast to help feed them, or you may need to feed it with a special bottle.
- hearing monitor – a baby born with cleft palate has a greater chance of gumming, which can affect hearing. Accurate monitoring of their hearing is important and if gomoor significantly affects their hearing, a hearing aid can be fitted or small tubes, called grommets, placed in their ears to drain the fluid.
- speech and language therapy – a speech and language therapist will monitor your child’s speech and language development during their childhood and help with speech and language problems
- good dental hygiene and orthodontic treatment – you will get advice on caring for your child’s teeth, and they may need braces if their adult teeth do not come through properly.
Prospects for cleft lip and palate
The majority of children treated for cleft lip or palate become normal.
Children most affected have no other serious medical problems, and treatment can usually improve the appearance of the face and problems with nutrition and speech.
Surgery to repair a cleft lip can leave a pink scar above the lips. It will fade over time and become less noticeable as your child gets older.
Some adults who have repaired a cleft lip or palate may be self-conscious or unhappy about their appearance. Your GP may refer you back to an NHS split center for further treatment and support if there are ongoing problems.
Will there be a cleft lip and palate again?
Most cases of cleft lip or palate are one-off and it is unlikely that you will have another child with the condition.
The risk of having a child with a cleft lip or palate is slightly increased if you have had a child before, but the chances are that it is about 2 to 8%.
If you or your partner was born with a cleft lip or palate, your chance of having a cleft baby is also around 2 to 8%.
The chance that another child is born with a cleft or that a parent transmits the condition to their child may be greater in cases related to a genetic condition.
For example, a parent with 22q11 deletion syndrome (DiGeorge syndrome) has a 1 to 2 chance of transmitting the condition to their child.
SOURCE: NHS