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Cleft  Lip and Cleft Palate

Tilt your head back a bit and look in the mirror. Do you see the way your nose connects to your upper lip?

Now open your mouth. Do you see the seam on the roof of your mouth? Sometimes you can feel it with your finger or your tongue. That's where your palate grew together in the middle. You can see that the palate goes from behind your top front teeth all the way to the back of your mouth.

What's a Cleft Lip or Cleft Palate?

The word cleft means a gap or split between two things. A cleft lip is a split in the upper lip. This can happen on one or two sides of the lip, creating a wider opening into the nose. A cleft palate is a split in the roof of the mouth. This leaves a hole between the nose and the mouth.

Sometimes a cleft lip and cleft palate occur together. Cleft lip and cleft palate are very common and occur in about 1 or 2 of every 1,000 babies born in the United States each year.

Cleft lip and cleft palate are birth defects. This means they happen while a baby is developing. Normally, the mouth and nose of a baby develop between the first 6 and 12 weeks of growth inside the mother. In some babies, parts of the lips and roof of the mouth don't grow together. Because the lips and the palate develop separately, it's possible to have cleft lip alone, cleft palate alone, or both together.

We don't always know why a particular baby has cleft lip or cleft palate. Sometimes the condition runs in families. This means that a person with cleft lip or cleft palate may have a relative with the same thing.

Other times, cleft palate is part of a syndrome, meaning there are birth defects in other body parts, too. Sometimes a cleft may be related to what happened during a mother's pregnancy, like a medication she may have taken, a lack of certain vitamins, or exposure to cigarette smoke. Most of the time, however, the cause of the cleft is unknown.

What Happens to a Kid With Cleft Lip or Cleft Palate?

A baby with cleft lip and cleft palate may have other difficulties that include feeding problems, middle ear fluid and hearing loss, dental problems, and speech problems.

Feeding problems

Have you ever laughed so hard while drinking milk that it came out of your nose? Because there is a hole between the nose and mouth in babies with a cleft palate, they have the same problem, but it can happen every time they drink and not just when they laugh. Fortunately, there are feeding specialists and special baby bottles that can help.

Ear and hearing problems

Kids with cleft palate can have hearing loss. This may be caused by fluid building up inside the ear. They usually need very small special tubes placed in their eardrums to help them hear better. Therefore, children with cleft palate should have their ears and hearing checked about once or twice a year.

Dental problems

Children with cleft lip or palate often have dental problems. These problems can include small teeth, missing teeth, extra teeth, or crooked teeth. All kids need to see the dentist regularly and keep their teeth clean. A kid with a cleft might need to go to the orthodontist for braces, too, to make sure his or her teeth grow in straight.

Speech problems

Kids with cleft lip or cleft palate may also have problems with speech. When you talk, the muscles of your soft palate help to keep air from blowing out of your nose instead of your mouth. Kids with cleft palate find their soft palate sometimes does not move well and lets too much air leak out the nose while speaking. That gives them problems with certain sounds and it makes them sound like they are speaking partly through their nose.

What Do Doctors Do?

Treating cleft lip or cleft palate takes a team of different types of specialists (in this case, people who are experts in helping kids with clefts). This team includes a plastic surgeon, a speech-language pathologist, an orthodontist, an otolaryngologist (a doctor trained in ear, nose, and throat problems — say oh-toh-lar-un-gah-lo-jist), an oral surgeon, a dentist, a geneticist, a social worker, a psychologist, an audiologist, and other health care specialists. Because there are so many different people for a kid to see, the team has a coordinator who works with the parents to help organize everything.

Kids with cleft lip and palate will need several surgeries to fix the cleft. The cleft lip is usually repaired by the time the baby is between 3 to 6 months old. During surgery, the doctor closes the gap in the lip. A person who has cleft lip repaired as an infant will have a scar on the lip under the nose.

The cleft palate is usually repaired at age 9 to 12 months. During surgery on cleft palate, doctors close the hole between the roof of the mouth and the nose and reconnect the muscles in the soft palate.

After surgery, kids will get regular hearing tests to check for hearing problems caused by fluid building up in the ears. If they have special tubes placed in their eardrums, the otolaryngologist will check to see if they are working properly in keeping the fluid from building up.

Lots of kids, including those with cleft lip or palate, need orthodontics or braces after their permanent teeth grow in. Braces can straighten crooked teeth.

Kids with cleft lip and cleft palate may also need a bone graft when they're about 8 years old. In a bone graft, a surgeon takes some bone, usually from the kid's hip, and uses it to fill in the gap in the upper gum area. This allows the upper gum area to hold the permanent teeth better and keep the upper jaw steady.

As kids with cleft lip or cleft palate grow older and become teenagers, some may want to have their scars made less noticeable, their jaws aligned, or their noses straightened. Operations to do these can improve a person's bite, speech and breathing, and appearance.

Living With Cleft Lip or Cleft Palate

Some kids with severe cleft lip or cleft palate have a flattened nose or small jaw. Other kids with just cleft palate may look just like everyone else. Either way, kids with cleft lip or cleft palate want to be treated like everyone else. A person might have cleft lip, but also have beautiful eyes, a great sense of humor, or a terrific slam-dunk!

If you have cleft lip or cleft palate, there may be some things about your face you can't change and some that you can. Doctors can do amazing things to make you feel good about the way you look on the outside, and you can do things to make yourself feel good about the way you are on the inside.

Even with the many successful operations and treatment for cleft lip and palate, some kids have a hard time growing up with this condition. They may have classmates who tease or bully them or who are just curious and want to know more about it.

In either case, kids with clefts can get help handling these situations by speaking with their parents, teachers, or counselors, and of course, any member of their cleft palate team. The good news is that kids with cleft lip or cleft palate can grow up to be healthy, happy adults!

Reviewed by: Joseph A. Napoli, MD, DDS, and Linda D. Vallino, PhD, MS, CCC-SLP/A, FASHA
Date reviewed: January 2011

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Note: All information is for educational purposes only. For specific medical advice, diagnoses, and treatment, consult your doctor.
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