What is Cleft Lip and Cleft Palate?

Guest post by Holly Sanford, RN

Many parents find themselves wondering, "what is cleft lip and cleft palate" especially during pregnancy. An interesting fact that most people don’t know is that everyone starts out with a cleft lip and cleft palate. As the face is growing the cells move from the back/sides of the head and push into the face to create the lip and the palate. If the cells can’t grow fast enough to touch, or they touch but can’t join/fuse, there is a cleft (or separation) in the lip or palate. You can have a cleft/separation in several combinations: cleft lip; cleft lip and palate; cleft palate.

Our Dr. Noze Best founder, Dr. Steven Goudy, a distinguished pediatric ENT, performs complicated cleft lip and cleft palate procedures often for his patients, so we wanted to highlight the importance of learning more about it as a parent. The month of July is National Cleft and Craniofacial Awareness Month, so now more than ever we wanted to raise awareness. 

What is Cleft Lip and Cleft Palate?

Cleft lip and cleft palate are one of the most common congenital differences, affecting around 1 in 700 babies worldwide. The cleft lip and cleft palate may occur independently or together, and many children with the diagnosis do not have other differences. The demographics of patients who experience this difference the most include children of Asian, Hispanic, or Native American decent, however cleft lip and palate can present in any demographic.  

Causes of Cleft Palate

While the exact cause of cleft lip and cleft palate is unknown in every case, genetic and environmental causes have been identified. If your child has a cleft lip and/or palate, you should consider a genetics evaluation to determine the risk of cleft lip and/or palate for additional children. Additionally, risk factors such as smoking, certain medications and maternal diabetes have been associated with cleft lip and palate. 

What Parents Need to Know About Cleft Lip

Cleft lip occurs when the tissues of the lip fail to properly join/fuse during weeks four to seven of pregnancy. A cleft/separation can exist on either side of the lip or on both sides. A cleft lip can be a small notch or it can extend all the way into the nose.

There are five different types of cleft lip:

• Forme fruste unilateral (one side) cleft lip- a small, subtle invention on one side of the upper lip
• Incomplete unilateral (one side) cleft lip- a cleft on one side of the upper lip that does not extend to the nose
• Complete unilateral cleft lip- a cleft on one side of the upper lip that extends to the nose
• Incomplete bilateral (both sides) cleft lip- clefts on both sides that do not extend to the nose
• Complete bilateral (both sides) cleft lip- clefts on both sides that extend to the nose

Repair of a cleft lip may occur as early as 2 months and as late as 6 months depending on other medical concerns, whether additional therapies are used to narrow the width of the cleft (taping or molding), and family/surgeon preference. Cleft lip and palate repair at the same time is not common.

What Parents Need to Know About Cleft Palate

A cleft palate forms when the roof of the mouth does not completely fuse during weeks six through twelfth of pregnancy. The opening extends into the nasal cavity and it may occur on either side of the palate. The cleft palate may expand from the front of the mouth to the throat.

There are three different types of cleft palate:

• Incomplete cleft palate- a cleft in the soft palate (back of the mouth)
• Complete cleft palate- a cleft in the hard and soft palates (front and back of the mouth)
• Submucous cleft palate- a cleft that is covered by the mucous membrane that may involve the hard or soft palate

Babies with cleft palate are unable to breast feed as a primary modality, as they are not able to generate suction force due to the connection/cleft between the oral and nasal cavities. Use of a specialty bottle with consultation of a speech therapist or lactation consultant with expertise in feeding babies with cleft lip and palate is important.  Connecting the baby with the breast at the end of feeds is encouraged for bonding.

Additionally, ear infections and potential hearing loss may occur with cleft lip and palate diagnoses. The palate muscles assist in draining fluid from the ears. Without a properly repaired palate, the middle ear (behind the ear drum) may not drain properly and cause ear infections. Once the palate muscles are repaired the fluid may start to drain better. 

Most children with a cleft palate will need ear tubes to drain the fluid and the tubes will be placed at the time of lip or palate surgery. The ear tubes fall out on average after 12 months and children with cleft palate will need an average of 3 sets of ear tubes over their lifetime (but can be higher). It is important to identify any potential hearing loss in children with cleft lip/palate as soon as possible and if hearing loss is found initiating therapy by 2 months of age (including hearing aids).

@drnozebest Doing bilateral cleft lip surgery is a struggle particularly when they are wide. It is very rewarding to restore form and function and the family was so happy! #CleftLip #Cleft #Cleft palate #Recovery #Beautiful #Grateful #Impactful #ILoveMyJob #ILoveKids#Healing #1StepForward #Surgery #Pediatrics #FYP #doctorsoftiktok ♬ original sound - Dr. Noze Best

Because the patients with cleft lip and palate may have issues with hearing and functional differences in the speech muscles in the palate, speech delays may be observed. Regular evaluations by speech therapy are helpful to children with cleft lip and palate and additional procedures can be implemented to improve speech.  Some patients that have had a cleft palate repair may require further surgery on the palate muscles to help them function better and improve speech.

Treatment for Cleft Palate

Fortunately, treatment options, including surgery and speech therapy, are available for children with cleft lip and palate.

Holly Sanford is a mother and a pediatric nurse of 9 years with a lifelong passion for helping children and their families. In her free time, she loves cooking new recipes, traveling to unique places and staying active with her family.