Cleft Lip & Palate
Brief Information
Introduction
Cleft lip and palate is a developmental problem in babies where the upper lip or palate (roof of the mouth) is not correctly joined, leading to a gap in either the palate or lip and palate.
There are a number of other situations where cleft lip and palate occurs in association with other birth defects. These are more common in cases where cleft palate occurs without cleft lip, and it is important that any cleft palate baby is thoroughly examined for other birth defects.
A cleft lip can range from a simple notch in the upper lip to a complete gap in the lip running into the floor of the nostril. The upper gum may also be involved. This may occur on just one side (unilateral cleft) or both sides (bilateral cleft).
Cleft palate may involve only the soft palate at the back of the mouth or may run forwards through the bone of the hard palate. As with the lip, one or both sides may be affected. Cleft lip and palate or cleft palate occurs in around 1 in 700 babies in the UK. Around 70% of babies with cleft lips also have cleft palates. Males are more commonly affected than females.
Causes
As the baby develops during pregnancy, the lip and palate form from tissues on either side of the tongue. These tissues normally join in the middle to form a single lip and palate.
If the tissues fail to join up in the middle of the face a gap occurs in the lip. This is usually on one side only, underneath either nostril (unilateral cleft lip) or sometimes beneath both nostrils (bilateral cleft lip). The lip usually closes around five to six weeks after conception and the palate at around ten weeks.
If the tissues forming the palate fail to join up, a gap is left in the roof of the mouth running up into the nose.
It is not entirely clear why this happens in some babies but cleft lip and palate can run in families so it is likely that there may be a genetic factor.
Some types of drugs taken in pregnancy may also increase the risk. These include anticonvulsives, usually taken for epilepsy, and drugs for insomnia and anxiety such as diazepam and corticosteroids.
Other possible causes include infections during pregnancy, smoking and alcohol use during pregnancy and deficiency of the B vitamin folic acid.
Treatment
Treatment of cleft lip and palate babies is long term and should continue until the child reaches around 18 years of age and stops growing.
There are around ten specialist centres for treatment of cleft lip and palate children in the UK and if you have a baby with a cleft lip or palate it is likely that your maternity hospital will refer you to one of these. The specialist teams involved include:
- Ear, Nose and Throat (ENT) surgeons
- Maxillo-facial surgeons
- Dentists
- Orthodontists
- Speech and language therapists
- Specialist nurses
- Psychologists
Surgery is the most common form of treatment for cleft lip and palate. It is often necessary to perform a number of operations as the child grows. The type of surgery required will vary on the severity of the problem.
The lip is usually operated on at about three months old. The gap in the palate is usually treated later, at around six months old. The operations are carried out in a hospital under general anaesthetic and it may be necessary to stay in hospital for 3-5 days.
More surgery may be needed as the child grows to improve the appearance of the lip and nose and the way the palate works. Gaps in the gum may also be filled with a bone graft.
Treatment with a speech therapist may also be necessary, as may orthodontic treatment to correct the position of the teeth.
Emotional support from specialist counsellors and psychotherapists is important throughout treatment as the process can be difficult for both parents and children.
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