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Head & Neck | Cleft lip and palate

Cleft lip and cleft palate are congenital birth defects. The conditions develop early in pregnancy, sometimes before a woman even knows she is pregnant.

In babies with a cleft lip, the upper lip does not form completely and there is a split in the lip. A cleft palate is a split in the roof of the mouth. About half of the time, clefts include both the lip and palate.

Most babies born with a cleft are otherwise healthy with no other birth abnormalities. For babies with cleft lip and/or palate that have no other health problems, the long-term outlook is excellent.

Essential Information

  • Cleft lip can vary in severity from a tiny indentation in the upper lip to a split that continues into the nose. In the same way, a cleft palate can range from a small separation in the roof of the mouth to a very large separation that interferes with feeding.
  • For every 1,000 babies born, approximately 1 or 2 will have a cleft lip and/or palate.
  • Cleft lip and cleft palate may have a genetic link, causing them to occur more often in certain families.
  • Sometimes cleft lip and/or cleft palate are part of a genetic condition or syndrome, but most often they occur by chance and can happen to anyone.

Overview

Cleft lip and cleft palate can be diagnosed by ultrasound during pregnancy, but they can be difficult to see on ultrasound and many are not diagnosed until after birth.

Some fetuses with cleft lip and/or palate may have another condition or syndrome, so it important to evaluate the fetus closely. Further tests include a detailed ultrasound that is used to assess other organs. A fetal echocardiogram (a detailed ultrasound of the fetal heart) may also be done in some circumstances.

An amniocentesis may be done to look for genetic or chromosomal problems. During an amniocentesis, a small amount of amniotic fluid is taken from around the fetus and tested for genetic problems.

Because babies with cleft lip and/or palate can have problems with feeding, it is important for them to be born where there is trained staff to support and manage any feeding issues. You may be referred to a specialized cleft lip and palate program where you’ll receive help with feeding issues. The baby/child may ultimately require care from a plastic surgeon, a paediatric dentist, an ear, nose and throat (ENT) doctor, an orthodontist, a paediatrician, an audiologist (hearing specialist), a speech-language specialist, an occupational therapist, and a nurse co-ordinator.

Treatment

All babies with cleft lip and/or palate will need surgery. Most of the time the cleft lip is repaired at approximately 3 months of age. Cleft palate is usually repaired between 6-18 months. Some babies need other surgeries as they grow.

Babies are usually seen by the plastic surgeon within the first week or two of life. The plastic surgeon will assess the cleft lip and/or palate and discuss a treatment plan.

Babies with cleft lip and/or palate are followed closely to make certain they gain enough weight and continue to thrive.

Babies with cleft lip and/or palate may have frequent ear infections. This is because they are more likely to have fluid buildup in the ear and this fluid can become infected. Frequent ear infections can lead to hearing loss. Your baby will have regular checkups by a hearing specialist and an ear, nose and throat (ENT) doctor.

Babies with a cleft palate may have speech difficulties because a cleft palate may make it difficult for the child to say words clearly. Your baby will receive regular evaluations by a speech-language specialist. This specialist will be able to help treat any problems in speech development.

Referral Information (for physicians)

All fetuses with a suspected cleft lip and/or cleft palate should be referred to a tertiary care centre, such as Mount Sinai Hospital, for evaluation.