Cleft Palate With Cleft Lip
What Is a Cleft?
A cleft is when a baby is born with an opening in the lip and/or roof of the mouth (palate). Cleft lip and cleft palate are called orofacial clefts. Because the lips and the palate develop separately, a child can be born with a cleft lip only, cleft palate only, or both.
These birth defects are treatable. Most kids can have surgery to repair them within the first year or two of life.
What Is a Cleft Palate?
A cleft palate (PAL-it) is when a baby is born with a cleft in the roof of the mouth. This leaves a hole between the nose and the mouth. It can be:
- a complete cleft palate: going from behind the front teeth to the back of the palate
- an incomplete cleft palate: affecting just the back of the palate, near the back of the throat.
What Is a Cleft Lip?
Babies who are born with cleft lip have a gap or opening in the upper lip. This happens when the baby's lip doesn't form properly early in pregnancy, resulting in a split.
A cleft lip can be:
- on one side of the lip (a unilateral cleft lip)
- on both sides of the lip (a bilateral cleft lip)
Clefts can range in size:
- Some are just a small notch in the lip (an incomplete cleft lip).
- Others extend from the lip through the upper gum and into the nostril (a complete cleft lip)..
What Is a Cleft Palate With Cleft Lip?
A cleft palate with a cleft lip is when a baby's lip and palate both do not form properly during pregnancy.
How serious the defects are can vary depending on the type of cleft lip and the type of cleft palate.
For instance, one baby might be born with:
- An incomplete cleft palate with an incomplete unilateral cleft lip: The baby has a cleft on one side of the lip only that does not extend to the nostril, and a cleft in the roof of the mouth that does not go all the way to the back of the palate.
But another baby might have:
- A complete cleft palate with a complete bilateral cleft lip: The baby has clefts on both sides of the lip that reach the nostrils and a cleft in the roof of the mouth that goes all the way back.
What Problems Can Happen?
Cleft lip and cleft palate can be associated with other problems, including:
- feeding problems
- fluid buildup in the middle ear and hearing loss
- dental abnormalities
- speech problems
So it's important to correct a cleft palate with cleft lip with surgery while a child is young.
How Is Cleft Palate With Cleft Lip Diagnosed?
While most cleft lips are noticed when a baby is born (or even seen on a prenatal ultrasound), a cleft palate is more difficult to see until the inside of the baby's mouth is examined carefully after birth. When a baby is born with a cleft lip, the doctors will also look for a cleft palate.
How Is Cleft Palate With Cleft Lip Treated?
Cleft Lip Repair
A plastic surgeon will repair the baby's cleft lip first, usually when the baby is 2–10 weeks old. This is done with a surgery called cheiloplasty (KY-lo-tuh-plass-tee). It's done in the hospital while the baby is under general anesthesia.
The goals of cheiloplasty are to:
- Close the cleft.
- Create a more normal appearance by:
- forming a cupid's bow (the curves in the center of the upper lip)
- creating more space between the upper lip and nose
If the cleft lip is wide, special procedures like lip adhesion or a molding plate device might help bring the parts of the lip closer together before the lip is fully repaired. Cleft lip repair usually leaves a small scar on the lip under the nose.
If the cleft lip also affects the shape of the nose, a baby might have other surgeries to improve its appearance (for instance, to fix the shape of the nostrils).
Cleft Palate Repair
A cleft palate usually can be repaired with surgery called palatoplasty (PAL-eh-tuh-plass-tee) when the baby is 6–12 months old. The goals of palatoplasty are to:
- Close the opening between the nose and mouth.
- Help create a palate that works well for speech.
- Improve swallowing and breathing.
In this palate reconstruction surgery, a plastic surgeon will:
- close the cleft down the middle in layers, connecting the muscles of the soft palate and rearranging them to close the cleft
- make two incisions (cuts) behind the teeth to help ease tension on the palate closure
This surgery requires general anesthesia and takes about 2–3 hours. Your child will stay in the hospital for several days for recovery. The stitches will dissolve on their own.
Your child will need a liquid diet for a week or two, then will eat soft foods for several more weeks before going back to his or her regular diet.
More surgeries may be needed as children grow older and their facial structure changes. This can include surgeries like:
- pharyngoplasty (fuh-RING-oh-plas-tee), which helps improve speech. This operation changes the shape and function of the soft palate and the pharynx. This sometimes can help with a nasal voice tone.
- alveolar (al-VEE-eh-lur) bone grafts, which can support permanent teeth and stabilize the upper jaw. A bone graft fills in the gaps in the bone or gums near the front teeth. It's usually done when kids are 6–10 years old.
As children become teens, they will likely want to (and should) be more involved in their care. They may want to:
- have their scars made less noticeable
- improve the appearance of their nose and upper lip
- improve their bite with orthognathic (or-thog-NATH-ik) surgery, which realigns the jaws and teeth
These operations may improve speech and breathing, overbites/underbites, and appearance.
What Else Should I Know?
Children with a cleft palate with cleft lip can have other health problems, such as:
- trouble feeding
- fluid buildup in the middle ear
- hearing loss
- dental problems
- speech difficulties
It's important to work with a care team to help manage any problems. Besides the pediatrician, a child's treatment team will include:
- plastic surgeon
- ear, nose, and throat (ENT) physician (otolaryngologist)
- oral surgeon
- speech-language pathologist
You might also work with a:
- social worker
- psychologist or therapist
- team coordinator
When Should I Call the Doctor?
Palatoplasty, cheiloplasty, and the other procedures done to help kids born with clefting have seen major improvements in recent years. Most kids who undergo them have very good results. There are risks with any surgery, though, so call the doctor if your child:
- has a fever above 101.4˚F
- has lasting pain or discomfort
- has heavy bleeding from the mouth
- can't drink fluids
Most kids with cleft palate with cleft lip are treated successfully with no lasting problems.
The psychologists and social workers on the treatment team are there for you and your child. So turn to them to help guide you through any hard times. You also can find more information and support online:
- American Cleft Palate-Craniofacial Association (ACPA)
- Cleft Lip & Palate Association
- FACES: The National Craniofacial Association
- Smile Train