Cleft Lip/Palate

Definition

Congenital abnormalities that affect the upper lip and the hard and soft palate. Features range from a small notch in the lip to a complete fissure (groove) extending into the roof of the mouth and nose. These features may occur separately or together.

Causes, incidence, and risk factors

Cleft lip and palate are facial and oral malformations that may occur separately or together. They may also occur in association with other syndromes or birth defects. The cause of these malformations may be mutant genes or teratogens (an agent that causes abnormalities in a developing fetus, such as certain viruses or chemicals).

As well as being disfiguring, these abnormalities can cause feeding difficulties, problems with speech development, and ear infections. Risk factors include a family history of cleft lip or palate and presence of another birth defect. The incidence of cleft lip and palate varies with different races; approximately 1 out of 1,000 Caucasians are affected. The incidence of cleft palate aloneis 1 out of 2,500 people.

Symptoms

• Separation of the lip alone
• Separation of the palate
• Separation of the lip and palate
• Varying amounts of nasal distortion
• Recurrent ear infections
• Failure to gain weight
• Nasal regurgitations during bottle feeding

Signs and tests

Physical examination of the mouth, nose and palate confirms the presence of cleft lip or cleft palate. Diagnostic testing may be performed to determineor rule out the presence of other abnormalities.

Treatment

Treatment of cleft lip and palate requires a team approach and involves several specialties, including plastic surgeons, orthodontics, speech therapists andothers. Treatment may extend over a period of several years.

Surgery to close the cleft lip usually performed at 3-6 months of age. Latersurgery may be needed if there is extensive nasal involvement.

A cleft palate is usually closed within the first year of life to enhance normal speech development. Until surgery, a prosthetic device is often fittedover the palate for feeding.

Continued follow-up may be needed with speech therapists and orthodontists.