Cleft Lip / Cleft Palate
What are cleft lip and cleft palate?
Cleft lip and palate are congenital abnormalities of the mouth and lip. A normal fetus has a split lip and palate, but early in pregnancy, the sides of the lip and the roof of the mouth should fuse. Failure of fusion results in cleft lip, which ranges from mild (notching of the lip) to severe (opening from lip to nose), and/or cleft palate, which can extend from the front of the mouth to the throat and often includes the lip.
Types of cleft lip/cleft palate conditions we treat
The Lip and Cleft Palate Program at The Children's Hospital of Philadelphia treats the following types of cleft lip/cleft palate conditions:
- Unilateral incomplete defect – Notching of the lip
- Unilateral complete defect – One opening from lip to nose
- Bilateral complete defect – Opening from lip to nose on both nostrils
- Cleft palate – Incomplete closure the roof of the mouth (can extend from the front of the mouth to the throat)
How many babies are born with cleft lip and cleft palate?
- In the United States, about 6,800 kids are born with oral-facial clefts every year.
- Cleft defects are more common in boys.
- Cleft defects are more common in Asians and certain groups of American Indians and are less common in African-Americans.
- Less than 13 percent of patients have other birth defects.
What causes cleft lip and cleft palate?
- The cause of cleft lip and palate is not completely understood, though we know that the condition arises from a combination of genetic and environmental factors.
- If parents without clefts have a baby with a cleft, the chance that they will have another baby with a cleft ranges from 2 to 8 percent.
- If clefts run in your family, genetic consultation is suggested.
What are the complications associated with cleft lip and cleft palate?
Beyond the cosmetic abnormality, other complications that may arise from cleft lip and cleft palate include:
- Feeding difficulties occur more with cleft palate abnormalities. The infant may be unable to suck properly because the roof of the mouth is not formed completely.
- Ear infections are often due to a dysfunction of the tube that connects the middle ear and the throat. Recurrent infections can lead to hearing loss.
- Due to the opening of the roof of the mouth and the lip, muscle function may be decreased, which can lead to a delay in speech or abnormal speech. Referral to a speech therapist should be discussed with your child’s physician.
- Your child may have dental problems requiring orthodontic treatment.
Feeding my baby with cleft palate
The most immediate concern for a baby with cleft palate is proper nutrition. Sucking for a child with cleft palate is difficult because of the poorly formed roof of the mouth. Children with cleft lip and without cleft palate do not usually have feeding difficulties. The following are suggestions regarding feeding:
- Breastfeeding is allowed, but it will take extra time and patience.
- Hold your infant in an upright position to help keep food from coming out of his nose.
- Small, frequent feedings are recommended.
- Some patients fare well with store-bought nipples with modification, but others may need the following (which can be bought here):
- Enfamil Cleft Palate Nurser by Mead-Johnson
- Haberman Special Needs Bottle by Medela
- Pigeon Bottle by Respironics
- Ross Cleft Palate Nipple
- In some cases, supplements may be added to breast milk or formula to help your infant meet his calorie needs.
Visit the Cleft Palate Foundation website for information on how to purchase bottles and other products manufactured for infants with cleft palate.
Cleft lip surgery
The goal of this surgery is to fix the separation of the lip. For most infants with cleft lip alone, the abnormality can be repaired within the first couple months of life - usually when the baby is 10 to 12 pounds. Sometimes, a second operation is needed.
After the surgery for cleft lip
- Your child may be irritable and feel mild pain.
- Your child may have to wear padded restraints on his elbows to prevent rubbing at the surgery site.
- Swelling, bruising, and blood around stitch sites are normal. Stitches dissolve or will be removed in five to seven days.
- Scars will gradually fade but will not completely disappear.
- An intravenous (IV) catheter will be used to give your child fluids until he can drink adequately.
Cleft palate surgery
The goal of this surgery is to fix the roof of the mouth so that your child can eat and talk normally. These repairs are usually performed when the child is 6 to 18 months old – a later time than lip repair; palate repair is a more complicated surgery and has the best outcome when the child is larger and better able to tolerate the surgery. Sometimes, a second operation is needed.
After the surgery for cleft palate
- Your child may experience more discomfort and pain with palate repair than with lip repair.
- Your child may have nasal congestion. This can be relieved with medication.
- Your child may be in the hospital for one to three days, during which he will be given antibiotics to prevent infection.
- Your child will have stitches on his palate. Stitches will dissolve after several days. If packing is placed on the palate, do not remove the packing until instructed.
- There may be bloody drainage from the nose and mouth. It is also normal to have temporary swelling, bruising, and blood at the surgery site.
- An intravenous (IV) catheter will be used to help give your child fluids until he/she can drink adequately.
Diet after surgery
- Breastfeeding, bottle-feeding, and cup-feeding may be allowed.
- Your child should eat only soft foods for seven to ten days after surgery.
- Do not use straws or pacifiers.
Activity after repair
Your child should not run, engage in rough play, or use “mouth toys” for one to two weeks after surgery.
Reviewed by: Jesse A. Taylor, MD
Date: September 2011