Cleft lip and palate

Answer 1

Definition

Cleft lip and palate are birth defects that affect the upper lip and the roof of the mouth.

Alternative Names

Cleft palate; Craniofacial defect

Causes, incidence, and risk factors

There are many causes for of cleft lip and palate. Problems with genes passed down from one or both parents, drugs, viruses, or other toxins can all cause such birth defects. Cleft lip and palate may occur along with other syndromes or birth defects.

A cleft lip and palate can affect the appearance of one's face, and may lead to problems with feeding and speech, as well as ear infections. Problems may range from a small notch in the lip to a complete groove that runs into the roof of the mouth and nose. These features may occur separately or together.

Risk factors include a family history of cleft lip or palate and other birth defect. About 1 out of 2,500 people have a cleft palate.

Symptoms

A child may have one or more of these conditions at birth.

A cleft lip may be just a small notch in the lip. It may also be a complete split in the lip that goes all the way to the base of the nose.

A cleft palate can be on one or both sides of the roof of the mouth. It may go the full length of the palate.

Other symptoms include:

• Misaligned teeth
• Change in nose shape (amount of distortion varies)

Problems that may be present because of a cleft lip or palate are:

• Failure to gain weight
• Feeding problems
• Flow of milk through nasal passages during feeding
• Misaligned teeth
• Poor growth
• Recurrent ear infections
• Speech difficulties

Signs and tests

A physical examination of the mouth, nose, and palate confirms a cleft lip or cleft palate. Medical tests may be done to rule out other possible health conditions.

Treatment

Surgery to close the cleft lip is often done at when the child is between 6 weeks and 9 months old. Surgery may be needed later in life the problem severely affects the nose area. See: Cleft lip and palate repair

A cleft palate is usually closed within the first year of life so that the child's speech normally develops. Sometimes a prosthetic device is temporarily used to close the palate so the baby can feed and grow until surgery can be done.

Continued follow-up may be needed with speech therapists and orthodontists.

Support Groups

For additional resources and information, see cleft palate support group.

Expectations (prognosis)

Although treatment may continue for several years and require several surgeries, most children with a cleft lip and palate can achieve normal appearance, speech, and eating. However, some people may have continued speech problems.

Complications

• Dental cavities
• Displaced teeth
• Hearing loss
• Lip deformities
• Nasal deformities
• Recurrent ear infections
• Speech difficulties

Calling your health care provider

Cleft lip and palate is usually diagnosed at birth. Follow the health care provider's recommendations for follow-up visits. Call if problems develop between visits.

References

Friedman O, Wang TD, Milczuk HA. Cleft lip and palate. In: Cummings CW, Flint PW, Haughey BH, et al, eds. Otolaryngology: Head & Neck Surgery. 4th ed. Philadelphia, Pa: Mosby Elsevier; 2005:chap 176.

Kliegman RM, Behrman RE, Jenson HB, Stanton BF. Cleft lip and palate. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 307.

Arosarena OA. Cleft lip and palate. Otolaryngol Clin North Am. 2007 Feb;40(1):27-60.

Answer 2

Definition

Cleft lip and palate are birth defects that affect the upper lip and the roof of the mouth.

Alternative Names

Cleft palate; Craniofacial defect

Causes, incidence, and risk factors

There are many causes of cleft lip and palate. Problems with genes passed down from one or both parents, drugs, viruses, or other toxins can all cause these birth defects. Cleft lip and palate may occur along with other syndromes or birth defects.

A cleft lip and palate can:

• Affect the appearance of the face
• Lead to problems with feeding and speech
• Lead to ear infections

Risk factors include a family history of cleft lip or palate and other birth defects. About 1 out of 2,500 people have a cleft palate.

Symptoms

A child may have one or more birth defects.

A cleft lip may be just a small notch in the lip. It may also be a complete split in the lip that goes all the way to the base of the nose.

A cleft palate can be on one or both sides of the roof of the mouth. It may go the full length of the palate.

Other symptoms include:

• Change in nose shape (how much the shape changes varies)
• Poorly aligned teeth

Problems that may be present because of a cleft lip or palate are:

• Failure to gain weight
• Feeding problems
• Flow of milk through nasal passages during feeding
• Poor growth
• Repeated ear infections
• Speech difficulties

Signs and tests

A physical examination of the mouth, nose, and palate confirms a cleft lip or cleft palate. Medical tests may be done to rule out other possible health conditions.

Treatment

Surgery to close the cleft lip is often done when the child is between 6 weeks and 9 months old. Surgery may be needed later in life if the problem has a big effect on the nose area. See also: Cleft lip and palate repair

A cleft palate is usually closed within the first year of life so that the child's speech develops normally. Sometimes a prosthetic device is temporarily used to close the palate so the baby can feed and grow until surgery can be done.

Continued follow-up may be needed with speech therapists and orthodontists.

Support Groups

For additional resources and information, see cleft palate support group.

Expectations (prognosis)

Most babies will heal without problems. How your child will look after healing depends on the severity of the defect. Your child might need another surgery to fix the scar from the surgery wound.

Children who had a cleft palate repair may need to see a dentist or orthodontist. The teeth may need to be corrected as they come in.

Hearing problems are common in children with cleft lip or palate. Your child should have a hearing test early on, and it should be repeated over time.

Your child may still have problems with speech after the surgery. This is caused by muscle problems in the palate. Speech therapy will help your child.

Calling your health care provider

Cleft lip and palate is usually diagnosed at birth. Follow the health care provider's recommendations for follow-up visits. Call if problems develop between visits.

References

Friedman O, Wang TD, Milczuk HA. Cleft lip and palate. In: Cummings CW, Flint PW, Haughey BH, et al, eds. Otolaryngology: Head & Neck Surgery. 4th ed. Philadelphia, Pa: Mosby Elsevier; 2005:chap 176.

Kliegman RM, Behrman RE, Jenson HB, Stanton BF. Cleft lip and palate. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 307.

Arosarena OA. Cleft lip and palate. Otolaryngol Clin North Am. 2007 Feb;40(1):27-60.

Reviewed By

Review Date: 05/01/2011

Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.