Carl R. Darnall Army Medical Center - Health Library

Oral-Facial Clefts

(Cleft Lip; Cleft Palate)

Definition

An oral-facial cleft is a birth defect. The lip or the roof of the mouth do not form the usual way. The defect may be a cleft lip, a cleft palate, or both. A cleft lip is a gap in the upper lip, often just below the nose. A cleft palate is a gap in the roof of the mouth or in the soft tissue at the back of the mouth. In most people, a cleft lip and cleft palate happen together.

Infant With Cleft Lip
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Causes  ^

Early in pregnancy, all babies have an opening in the lip and palate. As the baby grows, these openings should slowly grow together. By birth, they should be closed. For some reason, these openings fail to close in children with this defect. It may be due to a mix of genes and the environment.

Risk Factors  ^

A cleft palate is more common in females. A cleft lip with or without a cleft palate is more common in males. Other factors in the infant that may raise the chance of this defect are:

  • Having other birth defects
  • Having a sibling, parent, or other close family member born with an oral-facial cleft

Factors in the mother during pregnancy that may raise the chance of oral-facial clefts are:

  • Taking certain medicines, such as antiseizure drugs, thalidomide, or retinoic acid
  • Smoking
  • Consuming alcohol
  • Having diabetes
  • Being around toxins, such as heavy metals

Symptoms  ^

The major symptom of a cleft lip and cleft palate is an opening in the lip or palate.

Problem that can happen from this are:

  • Feeding problems, especially with cleft palate
  • Problems speaking
  • Hearing problems
  • Weight loss

Diagnosis  ^

Cleft lip or cleft palate can be diagnosed by looking at the newborn baby. A newborn with an oral-facial cleft may be referred to a team of specialists soon after birth. Rarely, a mild cleft palate may go undiagnosed for several months or even years.

Your doctor may be able to see a cleft lip before birth. It may be seen during a prenatal ultrasound. A cleft lip can be seen as early as 18 weeks into pregnancy. Cleft palate may be harder to see before birth because it is inside the mouth. Treatment can’t be started until after birth. However, diagnosis during pregnancy will give the parents and the medical team time to make a care plan.

Cleft lip and palate are sometimes linked to other health problems. Your doctor should be able to tell you if your child’s cleft is a sign of a larger problem. Some of these problems may need more treatment.

Treatment  ^

Surgery is the main treatment. The main goal is to close the gap in the lip and palate. Other surgery may also be needed for:

  • Bite alignment surgery if the jaw is not aligned the correct way
  • Plastic and/or nasal surgery for facial appearance and function

A cleft defect can make it hard for your child to eat or drink. Your child may be given a dental plate. This is placed in the roof of the mouth. It should make it easier to eat and drink until surgery can be done.

Cleft palates may also be linked to ear and hearing problems. If your child has a middle ear infection or fluid build-up, your doctor may advise:

  • Medications to treat infection or prevent fluid build-up
  • Surgery to drain built-up fluid and prevent future infections

Hearing testing should be done regularly. Rarely, children with cleft palate may need hearing aids.

Prevention  ^

Pregnant women and women who are likely to become pregnant can help prevent oral-facial clefts:

  • Consume 400 micrograms of folic acid every day. Folic acid intake may include a daily multivitamin and eating foods that have folic acid, such as:
    • Fruits and orange juice
    • Green, leafy vegetables
    • Dried beans and peas
    • Pasta, rice, bread, flour, and cereals
  • Do not smoke or drink alcohol during pregnancy.
  • Talk to your doctor about any medicines during pregnancy. Only use them as directed by your doctor.
  • Get early and regular prenatal care.
  • If you are thinking about having a child and have risk factors for oral-facial cleft:
RESOURCES:

Children's Craniofacial Association
http://www.ccakids.com

Cleft Lip and Palate Association
http://www.clapa.com

CANADIAN RESOURCES:

Health Canada
https://www.canada.ca

Women's Health Matters
http://www.womenshealthmatters.ca

REFERENCES:

Cleft lip and palate. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T115764/Cleft-lip-and-palate. Updated October 4, 2017. Accessed June 27, 2018.

Cleft lip and palate. Nemours Kid's Health website. Available at: http://kidshealth.org/parent/medical/ears/cleft_lip_palate.html. Updated October 2014. Accessed June 27, 2018.

Facts about cleft lip and cleft palate. Centers for Disease Control and Prevention (CDC) website. Available at: http://www.cdc.gov/ncbddd/birthdefects/CleftLip.html. Updated June 27, 2017. Accessed June 27, 2018.

Last reviewed June 2018 by Karri Kassir, MD  Last Updated: 6/26/2018