Overview

Overview

Overview

Cleft lip and cleft palate are birth defects that cause openings or splits in the upper lip, roof of the mouth (palate), or both. They happen when an unborn baby’s developing facial structures do not close completely. A baby can be born with one or both of these conditions.

Will My Child Have Both Cleft Lip & Cleft Palate?

cleft-palate-drawing.jpg

Children can have a cleft lip, cleft palate, or both of these. Most of the time, children have either a cleft lip and a cleft palate or an isolated cleft palate. With an isolated cleft palate, your child's gum line and lip are normal even though your child's palate is split.

The difficulties your child will have depend on their problem. As children grow, they often need surgery to improve how their face, nose, mouth, and throat look and work.

Caring for a child’s cleft involves correcting complex problems, treatments, and procedures. Some babies and children will need multiple surgeries to repair their cleft. But not every child with a cleft lip or cleft palate needs multiple surgeries.

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Different Types of Cleft Lip

Babies can have different types of cleft lip. These can include a complete cleft lip or a partial cleft lip (also called a microform cleft lip or incomplete cleft lip). 

Some babies have a cleft on one side. This is called a unilateral cleft lip. Other babies have splits on both sides of their mouth. This is called a bilateral cleft lip

Most of the time, a cleft lip extends through the gum line and into the palate. These children have both cleft lip and cleft palate. Each cleft is slightly different and your surgeon can discuss your child's specific treatment needs.

Unilateral Cleft Lip
Infant with cleft lip, one-sided deformity
Bilateral Cleft Lip
Infant with cleft lip, two-sided deformity

If your child has a cleft in their palate (roof of the mouth), the cleft can also affect the uvula, soft palate, soft and hard palate, or the whole palate and the gum line as well.

What Is the Palate?

Cleft palate
Hard palate deformity, complete unilateral cleft

The palate is the soft tissue in the back and roof of the mouth. The hard palate is the roof of the mouth. It is made of gingiva, which is similar to the tissue that surrounds your child's teeth.

The soft palate is located further back in your child’s mouth. The soft palate is in front of the uvula (the dangling piece of tissue in the back of the mouth). The soft palate has mucosa and muscle.

It’s important that the muscles in your child’s mouth move normally and travel across the palate correctly. This helps your child as they learn to talk.

When children have a cleft palate, the muscles in the soft palate do not run in the correct direction. Instead of running across the palate like muscles do in normal mouths, the muscles run from the front to the back of the mouth. 

Families have many options for choosing a surgery to correct a cleft palate. We encourage you to learn about one-stage and two-stage palate repair so you can choose the best surgery for your family’s unique needs.

When Should My Child Have Treatment?

Children with a cleft lip or cleft palate often need different types of care in stages as they grow. These treatments are different for cleft lip alone, cleft palate alone, and cleft lip and palate.

The table below is a suggested timetable for when your child should have different types of treatments. Your child will probably need both surgical and non-surgical treatments. Some children also benefit from an early midface surgery and cleft rhinoplasty (nose job)

Age Range Treatment/Intervention
Prenatal
  • Refer to facial plastic surgeon
  • Address psychosocial issues
  • Make a feeding plan
  • Involve cleft team members
Birth-1 month
  • Refer to facial plastic surgeon
  • Address psychosocial issues
  • Monitor breathing & airway
  • Monitor child's feeding & growth
  • Begin NAM
1-4 months
  • Monitor child's feeding & growth
  • Repair cleft lip
  • Monitor ears & hearing and need for tubes
  • Continue NAM
5-15 months
  • Monitor child's feeding, growth, & milestones
  • Monitor ears & hearing; consider tubes
  • Repair cleft palate
  • Oral hygiene instruction
16-24 months
  • Examine child's ears & hearing
  • Monitor speech & language development
  • Monitor developmental milestones
2-5 years
  • Assess child's speech & language
  • Monitor child's ears & hearing
  • Consider lip/nose surgery before school starts
  • Monitor development
6-11 years
  • Assess speech & language; manage VPI
  • Orthodontic interventions & alveolar bone grafting
  • Assess school/psychosocial problems
12-21 years
  • Jaw surgery (if needed)
  • Rhinoplasty (if needed)
  • Orthodontics: bridges & implants if needed
  • Genetic counseling referral
  • Assess school/psychosocial problems

 

Surgery or Treatment When Does This Treatment Happen?
Prenatal Counseling Before delivery
Alveolar Molding (or NAM) Before your child turns 1 month old
Primary Cleft Lip Repair 3 months old
Palate Repair 9-12 months old
Speech Surgery 4+ years old
Lip Scar Revision Variable (can happen at different ages)
Palate Expansion 5-9 years old
Alveolar Bone Graft After palate expansion
Midface Surgery (Le Fort or Jaw Surgery) 18 years or older
Cleft Septorhinoplasty (Nose Job) 18 years or older

Note: Some children benefit from having surgery to reduce the appearance of lip scars before they start grade school. Our surgeons will consider how much the scarring affects your child and if she must have other surgeries.

Feeding & Weight Gain

During one of your first visits, your surgeon will talk about feeding challenges. Most children with a cleft grow and develop normally and healthfully.

But some infants with a cleft need more help and attention to get the nutrition they need to grow and heal from their upcoming surgeries.

Your surgeon and other infant feeding experts will evaluate your child to make sure your infant doesn't have airway, breathing, or swallowing problems. These problems can interfere with feeding. For example, breathing problems can cause some children to choke and aspirate during feeding. During aspiration, milk can go into your baby's lungs.

Many providers don’t know about the challenges of feeding cleft babies. It’s important to find a doctor who knows about cleft feeding problems. Some doctors may not know how to evaluate your child or address your concerns. Our pediatric facial plastic surgeons work with children with breathing problems on a daily basis.

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