Cleft lip and palate

A cleft lip is a gap in the upper lip and can involve the gum as well. It can affect one side (unilateral) or both sides (bilateral) of the upper lip. It can be a small gap in the lip (incomplete cleft lip) or it can extend into the base of the nose (complete cleft lip).

A cleft palate can involve some or all of the soft palate and may extend into some or all of the hard palate in the roof of the mouth.
Clefts of the lip and palate can occur separately or together.

Cleft lips and palates occur during the first weeks of development in the womb. The lips are initially formed in three parts and palate in two halves, lying either side of the tongue. Then around the fifth or sixth week of gestation, the lips join, and around the seventh or eight week the palate joins. This joining process may fail completely or stop at any point, resulting in a cleft.

In any unaffected family, the chance of facial clefting is one in 700. If one parent or child has a cleft, the chance of clefting in future children is one in 25 to one in 40.

The main symptoms are the effect the condition has on feeding, speech, hearing and appearance.

If a baby has a cleft palate with or without a cleft lip, they might have trouble feeding properly because they can’t suck very well. The baby is unable to create a seal enabling them to create suction to get milk from the breast or bottle.

Some special bottles are used to help babies with cleft lips and palates feed. But difficulty with feeding can mean the baby may gain weight more slowly than is meant to happen over the first few months.

Other symptoms can include hearing problems as children with the condition are more at risk of glue ear. This can also lead to ear infections. As the palate plays an important role in speech it is important the cleft is repaired with surgery to reduce speech problems when the child is older.

Diagnosis of a cleft lip is possible by ultrasound scan during pregnancy. It may be spotted during the routine 20 week anomaly scan. Around 60–75 per cent of cleft lips are diagnosed this way.

In contract, a cleft palate on its own can’t be detected in this way because it won’t be seen on the scan. If a cleft palate is not detected before birth, it will be seen once a baby is born, during the routine baby check. A problem with feeding just after birth is a strong indicator that there may be a problem with the palate.

Treatment involves surgery. One operation for the lip and one for the palate is usual, but sometimes other operations may be needed to ensure the best possible outcome.

A cleft lip is usually repaired surgically when a baby is around three to four months old. An operation to repair a cleft palate usually takes place when a child is between eight and 12 months of age. The operations involve joining the tissues that have not joined before birth.

In the vast majority of cases, surgery is very successful. Most babies born with a cleft lip or palate will lead totally normal lives.

Children with a cleft lip or palate will be monitored closely as they grow and develop. This will include their hearing, jaw and teeth development and speech.

Most children are able to develop good speech and language skills following surgery. But sometimes a repaired cleft palate can make it difficult for a child to pronounce some sounds clearly. This may affect speech quality making it sound a bit ‘nasal’. A speech and language therapist will be able to help.

Most children will be able to speak normally. Occasionally, a child may need an extra operation to aid speech which involves reducing the amount of air that goes through the nose.

For teenagers, impaired growth of the facial bones may be a problem. This can be rectified by surgery when growth has finished.