When Karly talks to her friends, most of them don't know it took years of hard work for her to develop her speech skills. Karly was born with a condition called cleft lip and palate. As a child, she had several operations to fix the problem. Today the only sign of those surgeries is a slight scar on her upper lip.
What Are Cleft Lip and Palate?
Cleft lip and palate are birth defects that happen while a baby is developing in the uterus. During the 6th to 10th week of pregnancy, the bones and tissues of a baby's upper jaw, nose, and mouth normally come together (fuse) to form the roof of the mouth and the upper lip. If this doesn't happen properly, a baby could be born with a cleft lip or cleft palate, or both.
The palate is the roof of the mouth. The front part of the palate behind the teeth is hard. The back part near the throat is soft.
In babies with cleft palate, there is an opening between the roof of the mouth and the nose. This opening may be through part of the palate (either the soft part or hard part) or through the entire palate.
A baby born with a cleft palate often has a cleft lip as well. A cleft lip is a gap or opening in the upper (top) lip. Most of the time, a cleft is only in the upper lip and doesn't affect the lower lip.
A cleft lip can be either unilateral or bilateral.
With a unilateral cleft lip, the gap is only on one side of the lip under either the left or right nostril and might extend into the nose.
Babies born with a bilateral cleft lip have a gap on both sides of the lip, and they may have a deep split in the lip that extends into both nostrils.
A person with a cleft could have only a cleft palate, only a cleft lip, or both a cleft lip and a cleft palate. Cleft lip alone and cleft lip with a cleft palate occurs more often in boys, while cleft palate without a cleft lip occurs more often in girls.
What Causes Cleft Lip and Palate?
Doctors don't always know exactly why a baby develops cleft lip or cleft palate. They believe it may be a combination of two things:
- Genes. Both mothers and fathers can pass on a gene or genes that cause cleft palate or cleft lip.
- Environmental factors (outside influences). Pregnant women who take certain medicines — such as medicines to control seizures — may be more likely to have a baby with cleft lip or palate. Women who come into contact with certain chemicals when they're pregnant may also have a baby with a cleft.
Not getting the right nutrition during pregnancy may increase a baby's risk of being born with a cleft. That's why it's important for moms to get vitamins like folic acid. Smoking cigarettes and using drugs and alcohol during pregnancy increase the risk that a baby will have birth defects. Moms who drink four or more alcoholic drinks in a row during the first weeks of pregnancy have a higher risk of having a baby with cleft lip or cleft palate.
What Happens if Someone Has a Cleft Lip and Palate?
Because the palate is supposed to stop food and liquid from going up the nose when eating, newborn babies with cleft palate may have trouble breastfeeding. They might need to use a bottle with a special nipple.
Teens born with cleft lip and palate usually don't have trouble eating because their clefts were repaired when they were babies. But they may have a few remaining issues, such as:
- dental problems, like cavities and missing or badly formed teeth
- ear infections and, possibly, hearing loss from repeated infections and fluid buildup
- speech problems, like trouble pronouncing words
Most kids with clefts have no other health problems, but some might have:
- birth defects, like heart defects
- physical problems, like growth disorders and muscle weakness
- learning difficulties
What Do Doctors Do?
Most babies born with cleft palate have surgery to close the hole in the roof of the mouth when they're between 9 and 12 months old.
People with a complete cleft lip and palate need several surgeries to repair the cleft. These include cleft lip repair, cleft palate repair, and a bone graft to the upper jaw to close the bone gap in the gum area. Some people need more surgery on the palate or in the throat to improve speech.
A cleft palate team includes doctors with different specialties, such as:
- a geneticist (a doctor who specializes in conditions that are inherited)
- a plastic surgeon
- an otolaryngologist (a doctor who specializes in conditions of the ears, nose, and throat)
- an oral surgeon
- a dentist
- an orthodontist
- a speech-language pathologist
- an audiologist (hearing specialist)
- a social worker
- a psychologist or therapist
Because so many specialists are involved in treating cleft palate, one doctor usually oversees and coordinates the different treatments.
People with cleft lip or palate may spend a lot of time at the dentist and orthodontist. Hearing tests to check for hearing problems and speech therapy to improve speech skills and patterns are often part of treatment, too. Some kids with cleft palate may have an operation to put tubes in their ears to help prevent ear infections.
Although most cleft lip and palate surgeries are done while kids are young, some people also may have plastic surgery when they're teens or even adults. Plastic surgery can improve the bite and position of the jaws, help people breathe better, make the nose look better, and improve facial balance.
Someone born with cleft lip and palate may wonder, "Why me?" Psychologists and therapists often help teens deal with the emotional effects of cleft lip and palate, such as scarring from surgery, coping with speech problems, or improving self-esteem. Some teens join support groups or online forums where they can talk to other people who were born with cleft lip or palate.
Reviewed by: Rupal Christine Gupta, MD
Date reviewed: August 2014
Originally reviewed by: Joseph A. Napoli, MD, DDS, and Linda D. Vallino, PhD, MS, CCC-SLP/A, FASHA