Cleft lip and/or palate is one of the most common birth defects, affecting approximately one in 700 babies born in the U.S. each year. A cleft lip is an opening in the lip, ranging from a small split in the lip to a larger gap that extends to the nose. Cleft palate, which is more common than cleft lip, is an opening in the roof of the mouth that, like cleft lip, can vary in size and location.
Whether the conditions occur individually or together, children may face complications including difficulty eating, frequent ear infections, impaired dental development and trouble speaking. However, advanced treatment options can give a child diagnosed with cleft lip and/or palate the chance to overcome these obstacles.
What causes cleft lip and palate?
Because a baby's facial features form very early in pregnancy, a cleft lip can be identified as part of standard prenatal care during an ultrasound. Cleft palate is rarely diagnosed before delivery because it is difficult to see the palate on ultrasound.
- The face develops between the fourth and seventh week of pregnancy. A cleft lip can form if the middle and lateral parts of the lip do not completely connect during this process. Most cases of cleft lip also involve the gums and the palate.
- The roof of the mouth forms between the sixth and ninth week of pregnancy. If the palate does not completely fuse, a cleft palate occurs.
Though the exact cause of cleft lip and palate is unknown, it is believed to be the result of a combination of genetic and environmental factors. Genes that lead to the condition can be inherited from either parent; other causes, such as certain medications taken by the mother during pregnancy, may also contribute.
"It is important to remember there are many genes which individually contribute to the chance your child will have cleft lip and/or palate," says Christopher Derderian, M.D., Pediatric Plastic Surgeon at Children's Health℠ and Assistant Professor at UT Southwestern. "It is a combination of factors. One single genetic mutation from one parent is rarely the cause of cleft lip or cleft palate."
Can cleft lip and palate be prevented?
Often, it is difficult to link the cause of cleft lip and palate directly to a specific genetic or environmental cause. However, expectant mothers can reduce the risk of their babies developing the condition by decreasing exposure to environmental factors that may affect development, especially early in pregnancy when the cleft lip begins to form.
To reduce risk, it's important for moms to:
- Quit smoking
- Stop drinking alcohol
- Avoid taking certain medications
- Maintain a healthy weight
- Manage diabetes or prediabetes
- Take prenatal vitamins
If you or your partner have a family history of cleft lip and/or palate, you might also consider meeting with a genetic counselor to discuss testing and treatment options.
How are cleft lip and palate treated?
A baby diagnosed with cleft lip and/or palate should be seen by a specialist within the first few days of life. Since cleft palate may limit a baby’s ability to drink milk from the breast or a bottle, feeding specialists will evaluate the baby to first make sure the baby is able to eat and is gaining weight. The care team will talk with parents about bottles uniquely designed for cleft lip and palate, and you may start discussing pre-surgical options such as a nasoalveolar molding device (NAM).
"Cleft lip and palate can affect many aspects of a baby's growth, and requires supportive treatment from a variety of specialties," explains Dr. Derderian. If your child is diagnosed with cleft lip and/or palate, your team of specialists should include:
- ENT provider
- Oral surgeon
- Pediatric dentist
- Pediatric orthodontist
- Pediatric plastic and craniofacial surgeon
- Social worker
- Speech therapist
Each specialist will meet with you individually during the same appointment. After the appointment, the team gathers to discuss your baby's case and ensure the treatment plan takes an integrated approach to address your baby's needs.
When your baby is 1-2 weeks old, you will meet with the orthodontist to begin discussing presurgical treatment. A NAM device is the preferred pre-surgical treatment to gently narrow the gap between the lip and nose. Treatment will involve surgery, which is often scheduled when your baby is 3 months old. Surgeries can include cleft lip repair surgery, reshaping of the nose, cleft palate repair surgery and ear tube surgery.
After surgery, you and your baby will continue to work with your care team to continue the treatment plan. As your child grows, this may include speech therapy, dental work or additional surgeries.
"We follow our patients from our initial meeting when they are just a few weeks old all the way through adulthood," says Dr. Derderian. "We want to ensure they receive the most comprehensive care at every stage of life."
Children's Health performs the most pediatric plastic surgery procedures and the most cleft lip and cleft palate surgeries in the region. Children's Health is also home to the Analytical Imaging and Molding Center (AIM) to plan for and optimize cleft treatment through research. Learn more about our cleft lip and palate program and services.