Cleft lip and palate

Definition

Cleft lip and palate are congenital (present from before birth) abnormalities that affect the upper lip and the hard and soft palate of the mouth. Severity of the abnormalities may range from a small notch in the lip to a complete fissure (groove) extending into the roof of the mouth and nose. These features may occur separately or together.

Causes, incidence, and risk factors

Cleft lip and palate may occur in association with other syndromes or birth defects. There are numerous causes for these birth defects, including mutant genes inherited from one or both parents, and teratogens (drugs, viruses, or other toxins that can cause abnormalities in a developing fetus).

As well as being disfiguring, these abnormalities can cause feeding difficulties, problems with speech development, and ear infections.

Risk factors include a family history of cleft lip or palate and presence of another birth defect. The incidence of cleft lip and palate varies with different races. Approximately 1 out of 1,000 Caucasians are affected. The incidence of cleft palate alone is 1 out of 2,500 people.

Symptoms

• Separation of the lip alone
• Separation of the palate
• Separation of the lip and palate
• Varying amounts of nasal distortion
• Recurrent ear infections
• Failure to gain weight
• Nasal regurgitations during bottle feeding
• Growth retardation
• Misaligned teeth
• Poor speech
• Feeding problems

Signs and tests

A physical examination of the mouth, nose and palate confirms the presence of cleft lip or cleft palate. Diagnostic testing may be performed to determine or rule out the presence of other abnormalities.

Treatment

Treatment of cleft lip and palate requires a team approach and involves several specialties, including plastic surgeons, orthodontics, speech therapists, and others. Treatment may extend over a period of several years.

Surgery to close the cleft lip is usually performed at 3 - 9 months of age. Later surgery may be needed if there is extensive nasal involvement.

A cleft palate is usually closed within the first year of life to enhance normal speech development. Until surgery, a prosthetic device is often fitted over the palate for feeding.

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 extend over several years and require several surgeries depending upon the involvement, most children affected by this disorder can achieve normal appearance, speech, and eating. For some, speech problems may continue.

Complications

• Recurrent ear infections
• Hearing loss
• Dental cavities
• Displaced teeth
• Poor speech
• Lip deformities
• Nasal deformities

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 arise between visits.

Illustrations

Throat anatomy

Infant hard and soft palates

Cleft lip repair- series

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