Cleft Lip and Palate

Cleft lip and cleft palate occur when the tissues that make up the lips and the roof of the mouth do not join properly when they are developing in the womb. This can happen to any child, but the problem is more common in children of Asian, Latino or Native American descent. Scientists aren't completely sure why but believe that genetic and environmental factors are involved.

In some situations, cleft lip and cleft palate may be part of another medical condition, such as:

• Pierre Robin Malformation Sequence, a combination of birth defects including small lower jaw and breathing problems.
• Amniotic banding, a group of defects believed to be caused by entrapment of fetal parts in the uterus.
• Hemifacial Microsomia/Goldenhar Syndrome, when the lower half of one side of the face is underdeveloped and does not grow normally.

Another potential cause may be the medications a mother takes while pregnant. Some anti-seizure or anticonvulsant medications, acne medications containing isotretinoin, or methotrexate (a drug commonly used for treating cancer, arthritis, and psoriasis) have been linked to cleft lip and/or cleft palate birth defects. In most cases, however, the cause of a child's cleft is unknown and unpreventable.

How are cleft lip and cleft palate diagnosed?

Prenatal ultrasound can sometimes identify a cleft in an unborn child. After the child's birth, the malformation is usually visible. A physical examination of the mouth, nose and palate can confirm the presence of cleft lip or cleft palate.

What surgical treatments are used to help babies and children with cleft lip and cleft palate?

A series of procedures for cleft lip and palate can range from soft tissue and lip repair in infants to rhinoplasty and jaw surgery in older patients. Here is the typical timeline for corrective surgeries in a child born with a cleft lip and/or cleft palate:

• The first surgery performed, typically in infants between three and six months of age, is to close the lip. Lips are important for feeding and social interaction, which is crucial for a baby’s development.
• The second surgery usually takes place when a child is a year old. This procedure creates a functional palate, reducing the chances of fluid buildup in the middle ear, and aiding in the proper development of teeth and facial bones. This surgery is timed for when much of the upper jaw growth has taken place, so as not to interfere in its development but before the onset of speech.
• For some children, a third surgery may be done to repair the cleft in the gum line when the child is between 7 and 9 years old.
• Each surgery typically requires a one- or two-day hospital stay. Additional procedures relating to the palate, gum tissue and jaws may be required later in childhood and into the teenage years, depending on the severity of a particular child's condition.

Additional procedures may take place for children in their mid- to late teenage years if, for instance the upper jaw does not grow normally, and is too far back. This additional procedure will improve the child’s airway, breathing, occlusal function and appearance.

Plastic surgery such as rhinoplasty or to repair scars from the initial surgeries may done in the teen years too. The goals of these surgeries are to optimize facial function and make the child's lips, nose, and face look as normal as possible.

What is recovery from cleft lip or cleft palate surgery like?

After surgery, babies stay overnight in the hospital, where they're monitored to make sure they're breathing and feeding well. A specially designed bottle that optimizes milk flow may be used for feeding for several weeks, because some babies aren't able to perform suction feeding. About a week after surgery, the sutures in the lip area are removed. The stitches used for the palate dissolve on their own. During the years after surgery and throughout childhood, the child's speech and dental functions will be monitored by specialists to ensure that they're developing and on track. Ideally, the child's face will develop with little or no visible evidence that he or she was born with a cleft lip and/or palate.