Cleft Palate

In the early stages of fetal development the right and left sides of the roof of the mouth and the upper lip grow together. Occasionally, these structures don’t fuse together normally. This happens in approximately 1 in 800 births and is one of the most common birth defects. The incidence of this condition varies in different countries and people of different ethnic backgrounds. When a child is born with a separation of the upper lip it is known as a “cleft lip,” and when born with a separation of the roof of the mouth it is known as a “cleft palate.”

There are different degrees of severity of this condition, ranging from a minimal separation (like a notch) of the lip to a full cleft of the lip that extends up into and involves a separation of the base of the nasal vestibule. In most cases this only involves one side and is known as a unilateral cleft lip. However, in some cases, both sides of the upper lip and nose are involved and this is known as a bilateral cleft lip. The repair of the lip may be performed several weeks after birth, but in many cases can be performed within days after birth (neonatal cleft lip repair), even before the child leaves the hospital.

Like cleft lip, cleft palate deformities may involve either one or both sides of the roof of the mouth. The defect may extend through the alveolus (gum line where the tooth buds form.) This deformity has implications that affect not only ability to suckle and feed properly, but also the ability to speak properly. Cleft palate repairs are usually performed between the ages of 5months and 2 years, depending on the child’s overall growth and development. Speech therapy is usually required for several years after palatoplasty, in order to obtain the best possible outcome for speech development.

Cleft lip and cleft palate deformities can be isolated events or may occur simultaneously. Conditions that are minimal, such as a minimal defect of the lip might only require one surgery to correct. However, more severe deformities, such as complete cleft lip and palate, usually take multiple staged procedures to repair over the course of a child’s lifetime. Such procedures may include lip repair, palate repair, alveolar bone grafting, orthodontics, scar revisions, rhinoplasty, and orthognathic surgery (upper or lower jaw surgery.) Although clefts may occur in patients with no known family history of such birth defects, once a child has been born with this condition there is an increased chance that future children born may have similar conditions. This risk varies and a genetics consultation may be indicated for further evaluation of such risks