A cleft lip is an opening in the lip. A cleft palate is an opening in the roof of the mouth. Both are caused by incomplete development before birth. 

Occurring in one in 600 births each year in the U.S., cleft lip and cleft palate are among the most common conditions found in newborn babies.

Wake Forest Baptist Health's cleft and craniofacial team is a national leader in cleft and craniofacial care, and has served patients throughout the region since 1977. 

Cleft lip and cleft palate can occur separately, or at the same time.

  • Cleft lip: The lip forms during the second month of development, when three separate parts come together. Usually, two vertical lines called “philtral columns” are present where this fusion occurs. When the parts from the side don’t fuse with the center part, a unilateral (single) or bilateral (double) cleft lip occurs. 
  • Cleft palate: Cleft palate occurs in a similar way, when the left and right parts of the palate fail to fuse normally. 

It’s important to have a child followed by a formal cleft team, as care is best provided using a multidisciplinary approach. Wake Forest’s cleft team includes speech and swallow therapists, audiologists, geneticists, orthodontists, plastic surgeons, and otolaryngologists. 

Identifying Cleft Lip and Palate

Clefts that involve the lip are usually identified during prenatal ultrasound. A cleft palate which occurs without cleft lip isn’t often seen with ultrasound, and may come as a surprise to families when the baby is born.

Effects of Cleft Lip and Palate

Clefts can affect babies and children in different ways. A cleft palate can make it difficult to feed adequately, and babies may require a special bottle. 

Later in life, clefts can affect speech and the growth of the teeth or upper jaw. 

Caring for Children with Cleft Lip and Palate

Care for children with clefts is highly individualized. Newborn babies with clefts should be seen within the first few weeks of birth, for an assessment of feeding and weight gain by both a speech pathologist and plastic surgeon.

At Wake Forest Baptist, infants with a cleft lip may be offered “nasoalveolar molding,” in which a custom retainer is placed by Dr. Kate Lambert, a pediatric dentist, to help align the babies’ gums and shape the nostrils prior to surgery. 

Surgery to repair the cleft lip typically happens between three and six months of age. 

Repair of the cleft palate is performed around 12 months of age, and may be separated into two separate operations, depending on how wide the cleft gap is and whether it affects both the hard and soft palate. 

Beginning at age 3, children with clefts may begin attending formal cleft clinics, a once-a-year visit during which they’ll be seen by team members from each specialty. This allows us to comprehensively make recommendations to help address problems with hearing, speech, development, and tooth and jaw development.