Cleft lip and palate are birth defects that affect the upper lip and the roof of the mouth. 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.
What Is Cleft Lip and Palate?
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.
Our cleft team at Wake Forest Baptist Health includes speech and swallow therapists, audiologists, geneticists, orthodontists, plastic surgeons, and otolaryngologists.
Causes of Cleft Lip and Palate
There are many causes of cleft lip and palate. Problems with genes passed down from 1 or both parents, drugs, viruses, or other toxins can all cause these birth defects. Cleft lip and palate may occur along with other syndromes or birth defects.
A cleft lip and palate can:
- Affect the appearance of the face
- Lead to problems with feeding and speech
- Lead to ear infections
Babies are more likely to be born with a cleft lip and palate if they have a family history of these conditions or other birth defects.
Diagnosing 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.
Treatment of 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.
A cleft palate is most often closed within the first year of life so that the child's speech develops normally.
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 close the cleft lip is often done when the child is between 2 and 6 months old. Additional surgery may be needed later in life if the problem has a major effect on the nose area.
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.
Continued follow-up may be needed with speech therapists and orthodontists.