A cleft lip and/or palate is a congenital condition (from birth) that refers to a separation in the lip, gum line, or palate that occurs during pregnancy. The two sides do not fuse together, leaving a gap. All the tissues are present; they just did not close. The cleft can range from a small notch in the lip to a large gap extending to the very back of the soft palate.
Cleft Lip and Cleft Palate Frequently Asked Questions
What is a cleft lip and/or palate?
What causes a cleft lip and/or palate to form?
A cleft of the lip and/or palate occurs when the tissues that comprise the lip and/or roof of the mouth do not fully fuse during early fetal development, usually between the 4th and 10th weeks of gestation. No single factor causes clefts. Many factors may play a role.
Is tissue “missing” in the cleft? Are tissue grafts added?
No. Children with clefts generally have all the structures and tissue needed to restore normal shape and contour. There is no need to add tissue from elsewhere. The structures are separated and need to be brought back together.
How common are clefts in babies?
Cleft lips and cleft palates are among the most common congenital abnormalities. In the United States, clefts occur in 1 out of 700 births. A cleft lip with or without a cleft of the palate is more common in boys, and an isolated cleft palate is more common in girls.
How are cleft lips or cleft palates classified?
Clefts of the lip and/or palate are classified according to the area that is affected. Clefts of the upper lip may be right- or left-sided (unilateral) or involve both sides (bilateral). Clefts of the palate are designated by how much of the palate is involved and may include the soft palate at the back of the roof of the mouth, extend into the hard palate, or also involve the gum line. When a cleft involves the entire lip and palate, it is a complete cleft lip and palate.
What is the difference between a unilateral versus a bilateral cleft lip?
In a unilateral cleft, only one side has not fused. In a bilateral cleft, both sides have not fused. Neither type is more “severe” than the other, and one does not require more surgeries than the other. Both types of clefts have their own surgical challenges. For example, in the unilateral clefts, there is more asymmetry. In either event, the results of surgery can be outstanding, particularly when modern repair techniques and innovations are applied.
What is the difference between an incomplete and complete cleft lip?
When a child has a complete cleft lip, it extends into the nose. This means that the alveolar ridge (gum line) is involved in a complete cleft. With an incomplete cleft lip, the cleft only involves part of the lip, and the alveolar ridge is not always clefted. The nose can still have some shape asymmetry.
What other conditions are associated with cleft lip and palate?
Many clefts are isolated, although they can occur as part of a syndrome. There are over 400 recognized syndromes associated with clefts, including Van der Woude syndrome, Crouzon syndrome, Apert syndrome, Stickler syndrome, and 22q deletion syndrome. Genetic assessments are available to our families.
Depending on the type of cleft, other congenital anomalies may be present. For example, 20% to 30% of infants with an isolated cleft palate may have congenital cardiac defects.
What surgeries are available to a child with cleft lip and/or cleft palate?
Babies born with cleft lip and/or palate will be considered for different surgeries at specific times during their growth and development. Every child is unique, and so is their treatment and surgical plan. Early consultation with the team can help the family understand the individual timeline appropriate for their child’s type of cleft. Not all children will require all surgeries, but depending on their needs the following may be offered as options.
Cleft lip surgery is usually the first surgical procedure done for children born with cleft lip and palate. It is typically done at 4 to 6 months of age. At this age, children are able to safely handle the surgery, and the structures are large enough to repair with high precision. Results need to last a lifetime. This is especially true for cleft lip. The initial lip surgery offers the best opportunity to achieve the most beautiful possible result. At the time of lip surgery, an initial correction of the nose is performed. However, the nose will continue to grow and change into the teen years. Therefore, we initially limit the work we do to the nose so we do not compromise the future. Our team of plastic surgeons is nationally recognized as experts on this specific subject.
Cleft palate surgery is performed around 10 to 12 months of age in order to ensure good speech and communication. For young children with clefts that involve the gum line, closing the gum and providing some additional bone will help with tooth development and is performed between the ages 7 to 11 years of age. Children with a cleft palate may require speech therapy, and some may require additional surgery to improve speech. In early teen years, dental and orthodontic problems may require the help of the dental and orthodontic team, and in many cases, benefit from using braces to align the teeth. As children and teenagers, appearance is an important concern to allow for psychosocial well-being. Having a visible facial difference can be challenging. As such, touch-up surgery to improve the shape of the lip and the nose is available. Finally, when a cleft of the gum and/or palate is present, the growth of the upper jaw can be affected, and patients who develop an underbite may benefit from jaw surgery to bring the teeth and bone into better balance. This is usually done at skeletal maturity when growth is completed.