Cleft lip is formed in the upper lip as either a small gap or dent in the lip and can continue into the nose. Cleft palate is a condition in which the two plates of the skull that form the hard palate (roof of the mouth) are not completely joined. In most cases, when cleft palate is found, cleft lip is present as well. Although cleft abnormalities occur in approximately one in every 700 births, they can be treated with surgery shortly after birth with highly successful results. The recurrence rate for parents having a second child with this deformity is quite low — approximately a 3–5% chance.
Fetal cleft lip and palate are congenital abnormalities (an abnormality present at birth) caused by a failure in facial development during pregnancy.
The abnormalities are diagnosed through ultrasound (sonogram) when an asymmetry between the right and left nostril or a gap along the gumline appears. Evaluation of the craniofacial structure is part of the routine ultrasound examination done by many obstetricians as part of their routine prenatal care around the 20th week of pregnancy.
The specialists in the Institute for Fetal Health can provide consultations for parents expecting child with cleft lip.
Preparation for the Child's Birth
After a fetus is diagnosed with cleft lip and/or palate, the hospital's surgeons and nurses counsel parents about what to expect when their baby is born and reassure them that it is correctable after birth. One of the major obstacles parents find is that their baby is not able to nurse at the breast or use regular bottles, so the staff members focus on educating parents about the differences that they need to be aware of to breast feed or bottle feed their baby.
Parents are given special bottles designed to easily feed their baby and instructed on how to use them, so they are prepared when the baby is born. If a mother wishes to breast feed her baby, the baby may need supplemental bottles of pumped breast milk after some feedings until the infant is bigger and stronger. Sometimes the baby will not nurse long enough to reach the milk at the end of the feeding, which is the milk that has the highest concentration of fat and is needed for the baby to gain weight. For this reason, the mother may need to pump her milk after each nursing and supplement the other feedings.
The parents return for an appointment as soon as the baby is born for detailed examination and to receive further instruction on how to feed their child, since feeding is easier to teach after the baby is present.
If the baby has a cleft palate, he is immediately fitted for an intra-oral device similar to a retainer to block the hole in the roof of their mouth. This is a temporary solution until the surgery to repair the palate can be performed. It allows better feeding and helps direct proper growth of the roof of the mouth. When the baby is around nine months of age, the surgeons schedule surgery to correct the cleft palate, if present, by closing the hole in the roof of the mouth.
If the baby has a cleft lip, the surgery to close the gap in the lip and nostril is usually performed around three months of age. This surgery often corrects the obvious malformations on the outside of the face. The surgeons discuss these surgeries with the parents beforehand, explaining how it is performed and showing them illustrations of the procedure. The major repairs of both clefts are usually completed by the baby's first birthday. This is same child as shown above, four months after surgery.
Due to a newborn's outstanding healing abilities, the results of the surgery are excellent both aesthetically and functionally. Children born with this condition have an outstanding quality of life and a normal life expectancy.
The hospital offers the services of an entire cleft lip and palate team, which consists of physicians and staff in the following specialties: ear, nose and throat; dentistry; orthodontistry; plastic surgery; and speech.
Learn more about the surgical treatment in the Division of Plastic Surgery pages. The best edited source of information comes from Cleft Palate Foundation. While accurate, the information from the "Smile Train" is more directed to practitioners than families.