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Cleft Palate and Cleft Lip: What Causes Them and How Are They Treated?

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what causes oral clefts and harelip
Find out all about oral clefts

Every year, about 1,200 babies are born in the UK with a cleft palate or cleft lip. Often, parents will have received a cleft lip ultrasound diagnosis during check-ups, but a cleft palate isn’t so easy to diagnose in utero. Although this can be worrying and distressing news for parents, it’s reassuring to know that cleft palate treatment is widely practised and very successful.

Here, we’ll walk you through some of the common questions people have about these conditions. We’ll explain the difference between a cleft lip and palate, what causes each condition, and what cleft lip and cleft palate surgery involves. You can also read about the implications for your child’s teeth, and how to address possible complications that may occur after surgery to repair an oral cleft.

What is a cleft palate?

We can define the ‘palate’ as the roof or top of your mouth. The definition of a ‘cleft’ is a divide or split in something. So, the definition of a cleft palate is a hole or gap in the roof of the mouth. If there is a gap on both sides of the mouth, this is known as a bilateral cleft palate.

A soft cleft palate is when the gap occurs towards to back of the mouth, towards the throat, and a hard cleft palate is when the cleft is towards the teeth. Some people develop only a soft cleft palate, while for others both the soft and hard parts of the roof of the mouth are affected.

What is a cleft lip?

types of oral cleft
Oral clefts can be unilateral or bilateral

Cleft lip used to be called catlip or harelip (sometimes understandably misspelled as hairlip). A cleft lip is when there is a gap, or notch, on one or both sides of the lip, sometimes reaching as far up as the nostrils.

A bilateral cleft lip is when there are two notches, whereas a unilateral cleft lip is when there is only one notch or gap. Cleft lip surgery will be the same whether your baby has a bilateral or unilateral cleft lip.

What causes a cleft palate and lip?

The answer to what causes a cleft palate and what causes a cleft lip is generally the same, although a cleft palate on its own is more common, accounting for about 45% of cases. Doctors are unsure about exact cleft lip and cleft palate causes, but there are some ideas, including:

  • Genetics: People often ask whether a cleft palate is hereditary, or clefts in general. Around 2-8% of cleft palates and cleft lips are thought to have a genetic link.
  • Smoking and drinking alcohol during pregnancy: Certain studies suggest a small but significant increase in the chances of palate and lip clefts when tobacco and alcohol are used during pregnancy.
  • Obesity during pregnancy: This point is a bit controversial, but scientific studies have found links between a mother’s weight whilst carrying her baby and a baby with a cleft lip and/or palate.
  • Lack of folic acid during pregnancy: Folic acid is already known to be important for women when pregnant, and there are studies that say the risks of cleft lip and cleft palate in babies are reduced with taking folic acid.
  • Certain medications taken whilst pregnant: Medication that can prevent seizures, and some steroids, have been linked to cleft lip in babies as well as cleft palates.

How do oral clefts form?

When a foetus has been developing for about 4-7 weeks, the skull and face begin to grow. An oral cleft occurs when the front part of the face doesn’t join up fully.

Your cupid’s bow, or the little indent between your septum and top lip is where the face normally finishes joining together and there will normally be a very small indent, or cleft, here. This cleft under the nose is known as your philtrum.

Cleft palate and cleft lip problems

Cleft palate babies have slightly different problems to cleft lip babies. You might find a cleft lip or palate causes some or all of these issues:

cleft lip problems
After surgery there may be some complications
  • Cleft lip babies may have some problems breast or bottle feeding because they can’t form a seal. There are special teats for bottles that will help a baby to feed.
  • Cleft palate babies can be more likely to have some hearing problems and get more ear infections, because they have problems draining fluid from around the ear.
  • Even after surgery, sometimes a cleft palate affects adults in the form of a speech problem. This can be treated with a speech therapist.
  • Dental problems are common for children and adults who were born with a cleft palate; teeth can be missing or twisted. Dentists can normally fix this with braces, surgery, and/or prosthetic teeth of some kind.

Cleft lip and cleft palate treatment

When a baby is diagnosed with a cleft lip and/or palate, they will be assigned a Cleft Team with the NHS. This is a team of specialists who can help with:

  • Feeding difficulties
  • Regular hearing checks
  • Help before and after cleft surgery
  • Speech therapy
  • Correct dental care

Cleft lip surgery

When a cleft lip baby is around 3-6 months-old they will be able to have cleft lip surgery. It is normally pretty simple, done in about 2 hours whilst the baby is under general anaesthetic. The two parts of the lip will usually be stitched together and secured with dissolvable stitches.

If your baby has a double, or bilateral cleft lip, both gaps should be able to be treated in the same surgery. There may be more cleft lip surgery needed when they are older, depending how well the first treatment heals.

Cleft palate surgery

cleft palate picture
The hole in the palate is closed during surgery

A cleft palate baby can receive surgery at around 6-12 months old. Cleft palate surgery involves the surgeon bringing together muscle and soft tissue to close any gaps. Like with a cleft lip, if there is a bilateral, or double cleft palate they can be treated at the same time.

Bilateral cleft lip and palate surgery

Your NHS Cleft Team will talk about your options if your baby has a bilateral cleft lip and/or palate. Depending on your child’s needs, surgeries may be split up or done at different ages. Your doctor will explain the options to you, and you can ask for a second opinion if you have any concerns.

Differences between cleft lips and cleft palates

The table below shows the main differences we have discussed between these different types of oral cleft:

Cleft lip Cleft palate Both
Genetic Not common Not common Not common
Ultrasound diagnosis Likely Unlikely Likely
Increased risk of ear infections No Yes Yes
Feeding difficulties Yes Yes Yes
Age for surgery 3-6 months 6-12 months Lip surgery 3-6 months; palate surgery 6-12 months
Dental issues Unlikely Likely Likely
Speech issues Unlikely Likely Likely

 

Growing up after oral cleft surgery

cleft palate adult
Many patients don’t have obvious scars as adults

A cleft lip before and after surgery will look very different. Some parents say they find it a bit hard to adjust to their child’s new smile. If you feel worried you can speak to your Cleft Team or seek support from the charity CLAPA. There’s not such a noticeable difference with a cleft palate before and after surgery, but of course the hole or gap will be gone when your child opens their mouth.

Ear infections may still affect your child more frequently, and they might need some help from a speech therapist. There is a chance more cleft surgery will be needed to maintain the function of the mouth, nose, and lips and to improve facial aesthetics. You’ll need to follow the advice of your dentist to keep your child’s teeth clean, particularly if they are misaligned.

After receiving surgery as a child for cleft palate, adults and teenagers may still need extra medical care. Sometimes teeth don’t form where the clefts were and implants or veneers may be necessary. Adult teeth can come through twisted and this could call for braces as they grow up too. They might even need surgery to realign their jaws, as was the case for 18-year-old Matilda in the video below.

Dr Pixie invited 18 year old Matilda to the clinic to talk about her cleft lip and palate. Mathilda has undergone several operation to correct this birth defect, and has come to the clinic to share her experiences of dealing with this problem. For Matilda, it is her speech that is the most concerning aspect, and she is about to undergo a final operation to realign her jaw. The surgery is eye-watering, but it should give Matilda a much more normal jaw line and bite. On returning to see Dr Pixie, the results are incredible and she has now finished her long surgical journey.

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Conclusion

It can be worrying for a parent to be told their baby has a cleft lip or palate: we all want our babies to be perfect. Even though your baby has a cleft, which will mean surgeries, treatment, and possibly braces and dental implants in the years ahead, they should be able to live a pretty normal life.

If you look at pictures of a cleft palate or cleft lip before and after surgery, such as those provided by the Cleft Lip & Palate Association (CLAPA) here, you can see that it is not likely to have a long-term negative impact on your baby, you, or your family.

FAQs

Is a cleft palate genetic?

Doctors think that cleft palates and cleft lips are rarely genetic; probably only in about 2-8% of cases. However, there are some other genetic conditions that include cleft palate symptoms. Pierre Robin Sequence, also knows as Pierre Robin Syndrome, is caused by genetics and one of the symptoms is a cleft palate.

Although it sounds quite scary, when you look at Pierre Robin Syndrome pictures you will see that it is not something that drastically changes your child’s appearance. Cleft palate surgery is still possible in this case, too.

cleft lip after surgery
Scars should fade with age

After surgery, will there be a cleft lip scar?

As with any surgery, a small cleft lip scar will be visible. Your baby’s scar will fade over the years, although when babies with cleft lip become adults 97% believe there is still a physical difference. If you look at pictures of mouths with cleft lips before and after surgery you will see that scarring is usually minimal.

What are cleft palate symptoms?

The main cleft palate symptoms are the gaps that are visible in the soft and/or hard palate when a baby is born. A cleft lip ultrasound can identify cleft lips before birth, whereas cleft palates are harder to diagnose. As we’ve outlined above, there are problems that arise from this but they are very treatable.

What happens if an oral cleft goes untreated?

In developing countries, some parents can’t afford to treat oral clefts in their children. Cleft lip adults have problems breathing, eating, hearing, and speaking. There are charities that fund surgery in underdeveloped countries to treat this easily fixable condition. In the following video you can see one young Mexican boy with a cleft lip before and after surgery, which was funded by the charity Smile Train:

Meet Alan, a young boy who was born in a small Mexican village with a cleft. His family didn't know how to care for his cleft, but after a social worker told them about Smile Train, they were able to get him his life-transforming surgery.

Learn more at smiletrain.org

Cleft Palate and Cleft Lip: What Causes Them and How Are They Treated?

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Sources
NHS: Cleft lip and palate Consulted 8th April 2019.

NCBI: Maternal obesity is a risk factor for orofacial clefts: a meta-analysis. Consulted 8th April 2019.

CLAPA: Photo Gallery (Children) Consulted 8th April 2019.

NIH: Folic Acid May Prevent Cleft Lip and Palate Consulted 8th April 2019.

The American Journal of Public Health: Tobacco and alcohol use during pregnancy and risk of oral clefts Consulted 8th April 2019.

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