Cleft Lip & Cleft Palate

How Often Does Cleft Lip & Cleft Palate Occur?

In some 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 results of treatment for cleft lip and palate are usually excellent both aesthetically and functionally. Children born with these conditions have a good quality of life and a normal life expectancy.

If no other members of the family have had cleft lip or palate, the recurrence rate for parents having a second child with this condition is quite low — approximately 2% if your child has an isolated cleft palate and 4% if your child has cleft lip with or without a cleft palate.

What Are the Types of Cleft Lip & Cleft Palate?

Since an infant’s lips and the palate develop separately, it is possible for a child to be born with a cleft lip only, cleft palate only or both.

Consequently, the conditions can be categorized into three general categories:

• Cleft lip without a cleft palate (isolated cleft lip)
• Cleft palate without a cleft lip (isolated cleft palate)
• Both cleft lip and cleft palate

The condition can occur on one side of the mouth (known as unilateral clefting) or on both sides (known as bilateral clefting.)

What Causes Cleft Lip & Cleft Palate?

Cleft lip and palate are congenital abnormalities (an abnormality present at birth) caused by a failure in facial development during pregnancy.

Is Cleft Lip & Cleft Palate Genetic?

In many babies, it is impossible to pinpoint a cause of cleft lip and cleft palate. The best available research shows it is likely a result of genetic and environmental factors.

Genes that result in cleft lip and palate can be passed on by themselves or as part of a genetic syndrome. If there is a genetic predisposition to cleft lip and palate, there is usually a history of clefting in the immediate family. Family history of cleft lip and cleft palate, as well as some medications during pregnancy, are among the factors that can increase the risk of the condition.

How Is Cleft Lip & Cleft Palate Diagnosed?

Sometimes cleft lip and/or cleft palate 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. Often you can have a consultation with a pediatric surgeon before birth.

Sometimes the condition is not detected before a baby is born. The condition is not always detected in sonograms. When this happens, families usually begin a treatment plan as soon as possible after birth.

Preparation for the Child's Birth

When 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 breastfeed 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 breastfeed 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.

Treatment for Cleft Lip and Palate

A cleft lip is usually repaired surgically when the baby is between three to six months old. An orthodontic appliance may be used before and after the lip repair surgery to help align the lip and nose. A child with a very wide opening may need to have a temporary procedure that brings the parts of the lip closer together before the full lip repair is done.  

The goal of the surgery is to bring together the separation in the lip so that the lips work and look normal. Incisions are made on both sides of the cleft to create flaps of tissue that are then drawn together and stitched to close the opening. Surgery is performed in the hospital under general anesthesia and typically takes between three and four hours. In some cases, a patient and their family will meet with an anesthesiologist in a consultation prior to the procedure. 

What to Expect After Cleft Lip Surgery 

Caregivers can expect that baby will recover well after cleft lip repair. Normally, there are no feeding modifications associated with a cleft lip repair. Parents can expect that baby will stay overnight after their surgery to monitor feeding and pain control after the procedure. 

Caregivers will learn how to care for the surgical site from the surgical team. They will also learn about post-operative care such as nasal stenting, scar massage or any other recommendations for best outcome. 

Surgical Treatment for Cleft Palate 

A cleft palate is usually repaired between 10 and 12 months of age. The plastic surgeon carefully puts the tissue and muscles in a better position so that the opening between the nose and mouth is closed and the roof of the mouth is rebuilt. Incisions are made on both sides of the opening, and specialized flap techniques are used to reposition the muscles and the palate. The repair is then stitched closed, usually in the middle of the roof of the mouth, so that normal feeding and speech development can occur and growth can continue throughout the child’s life. Surgery for cleft palate is performed under general anesthesia. It typically takes three to four hours. In some cases, a patient and their family will meet with an anesthesiologist in a consultation prior to the procedure. 

Children are observed overnight in the hospital and remain there until they are comfortable and can drink sufficient fluids. Most children are eating and drinking comfortably after the first night and are discharged home at that time. 

The goal of surgery is to create a palate that works well for feeding and speech. Most children will have good speech after palate repair. If there is breakdown in the palate that does not heal in the first two months after surgery, this is called a fistula. If the fistula is felt to result in nasal leakage of air or fluids, then a fistula repair would be performed after at least six months following palate repair to be certain the tissues have adequately healed to withstand repair. Some children, however, may need further surgery on the muscles of the palate or the muscles of the throat to achieve normal speech. 

Routine post-operation care will be with a plastic surgeon on a frequent basis. After second year of life, the patient will have annual visits to multidisciplinary cleft team clinic. 

What to Expect After Cleft Palate Surgery 

In partnership with baby’s speech therapist, caregivers will be well prepared for cleft palate surgery. Since the baby will not be able to put any objects into their mouth after the surgery, a speech therapist will offer parents techniques and resources for feeding, such as open cup feeding, starting between six to eight months of age. 
Parents can expect that baby will stay overnight after their surgery to monitor feeding and pain control after the procedure. Usually, patients are sent home with elbow immobilizers to keep baby from putting their hands or objects into their mouth for at least four weeks after the procedure. 

Routine post-operation care will be with a plastic surgeon on a frequent basis. After second year of life, the patient will have annual visits to multidisciplinary cleft team clinic. 

Other Surgeries for Cleft Lip and Palate Repair 

Additional surgeries are dependent on the severity of clefting at birth, dental needs and patient growth. Some children may require a few surgical procedures at various ages to achieve their best outcome. Timeline of these surgeries are dependent on many factors, which are discussed in detail during appointments with the providers of the cleft team. 

Long-Term Effects of Cleft Lip

Long-term effects of a cleft lip are often unnoticed until school age, as this is when patients themselves start to notice that their lip and nose may look a little different than their peers. Lurie Children’s cleft lip and palate team includes psychologists and social workers to help with any possible issues related to confidence or socialization.

Lurie Children’s surgeons make every attempt to see that the scars after a cleft repair are minimized by hiding them in the normal contours of the upper lip and nose. Over time, the scars will fade, and your child’s ability to grow and function normally will continue to improve.

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.

Long-Term Effects of Cleft Palate

Long term effects of a cleft palate are related to speech and feeding. Lurie Children’s providers work to overcome secondary problems through the collaboration of our cleft and craniofacial team clinic providers.

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.

Lurie Children’s Cleft Repair Team

Lurie Children’s offers the services of an entire cleft lip and palate team, which consists of expert physicians and staff in the following specialties: ear, nose and throat; audiology; dentistry; orthodontics; plastic surgery; speech therapy; psychology and social work. Learn more about the Cleft Lip & Palate Program. Children will have annual visits to the multidisciplinary cleft team clinic after the second year of life.

Lurie Children’s recommend that all children with cleft lip and/or palate should be followed by a team certified by the American Cleft Palate-Craniofacial Association (ACPA). ACPA has recognized Lurie Children’s Cleft Lip and Palate/Craniofacial Team as an ACPA Approved Team.

Resources

Learn more about the surgical treatment in the Division of Plastic Surgery pages and the Lurie Children’s Cleft Lip and Palate Repair Program Page. The best-edited source of information comes from Cleft Palate Foundation.