An orofacial cleft is when a baby is born with an opening in the lip and/or roof of the mouth (palate).
How Do Clefts Form?
During the first 6 to 10 weeks of pregnancy, the bones and tissues of a baby’s upper jaw, nose, and mouth normally come together (fuse) to form the roof of the mouth and the upper lip. A cleft happens when parts of the lip and mouth do not completely fuse together.
A cleft lip may just look like a small opening on the edge of the lip, or it could extend into the nose. It may also extend into the gums. A cleft palate can vary in size. It could affect just the soft palate, which is near the back of the throat, or it also could make a hole in the hard palate toward the front of the mouth.
Cleft lip — most common in boys
Cleft palate — most common in girls
Cleft lip and cleft palate— more common in boys
Causes and Risk Factors
The causes of orofacial clefts among most infants are unknown. Some children have a cleft lip or cleft palate because of changes in their genes. Cleft lip and cleft palate are thought to be caused by a combination of genes and other factors, such as things the mother comes in contact with in her environment, or what the mother eats or drinks, or certain medications she uses during pregnancy.
Recently, CDC reported on important findings from research studies about some factors that increase the chance of having a baby with an orofacial cleft and they include:
- Smoking―Women who smoke during pregnancy are more likely to have a baby with an orofacial cleft than women who do not smoke.
- Diabetes―Women with diabetes diagnosed before pregnancy have an increased risk of having a child with a cleft lip with or without cleft palate, compared to women who did not have diabetes.
- Use of certain medicines―Women who used certain medicines to treat epilepsy, such as topiramate or valproic acid, during the first trimester (the first 3 months) of pregnancy have an increased risk of having a baby with cleft lip with or without cleft palate, compared to women who didn’t take these medicines.
- Opening on 1 or both sides of the roof of the mouth. It may go the full length of the palate.
- Just a small notch in the lip. It may also be a complete split in the lip that goes all the way to the base of the nose.
- Change in nose shape (how much the shape changes varies)
- Poorly aligned teeth
Orofacial clefts, especially cleft lip with or without cleft palate, can be diagnosed during pregnancy by a routine ultrasound. They can also be diagnosed after the baby is born, especially cleft palate. However, sometimes certain types of cleft palate (for example, submucous cleft palate and bifid uvula) might not be diagnosed until later in life.
A physical examination of the mouth, nose, and palate confirms a cleft lip or cleft palate. Medical tests may be done to rule out other possible health conditions.
Management and Treatment
Services and treatment for children with orofacial clefts can vary depending on the severity of the cleft; the child’s age and needs; and the presence of associated syndromes or other birth defects, or both.
Surgery to repair a cleft lip usually occurs in the first few months of life and is recommended within the first 12 months of life. Many children will need additional surgical procedures as they get older. Surgical repair can improve the look and appearance of a child’s face and might also improve breathing, hearing, and speech and language development. Children born with orofacial clefts might need other types of treatments and services, such as special dental or orthodontic care or speech therapy.
The goal of surgery is to create a palate that works well for speech. Some kids, however, will continue to sound nasal after cleft palate repair, and some may develop a nasal voice later on.
Dental and Orthodontic Treatment
Maintaining healthy teeth and preventing cavities is very important for kids with cleft lip and palate, who can have more dental problems than other kids. They should see a dentist regularly and brush and floss every day.
Kids with cleft lip and palate may begin orthodontic treatment as early as 6 years of age. It may start with palatal expansion, a process that makes the width of the palate normal. Later, it may involve braces to position the teeth. Your orthodontist will discuss these issues with you.
Some kids with a cleft might be missing a permanent tooth, which can be replaced with a removable appliance or, in early adulthood, a dental implant.
Some kids will need speech therapy after a repair is done. The speech-language pathologist will closely monitor your child’s progress and talk with you about whether therapy is needed.
Babies with just a cleft lip don’t usually have feeding problems. But when the palate is involved, feeding can be a bigger challenge.
Babies with feeding issues should be seen regularly by a doctor to make sure that they’re gaining weight well.
Middle Ear Fluid Buildup and Hearing Loss
Many children with cleft palate are at risk for fluid buildup in the middle ear. This fluid can’t pass through the Eustachian tube as it should, which can lead to ear infections and even hearing loss. So kids with cleft palate usually need ear tubes placed in their eardrums to help drain the fluid and improve hearing.
Kids with cleft palate should have their ears and hearing checked once or twice a year, or more if they are having hearing problems.
Children with a cleft lip and palate often have dental problems. These can include small teeth, missing teeth, extra teeth (called supernumerary), or teeth that are out of position. They may have a defect in the gums or alveolar ridge (the bone that supports the teeth). Ridge defects can displace, tip, or rotate permanent teeth or prevent permanent teeth from coming in properly.
Regular visits with a pediatric dentist who specializes in cleft lip and palate are important. The dentist will check a child’s mouth growth and development, identify any problems, and make treatments when needed.
Kids with cleft lip have fewer speech problems than those with cleft palate. About 1 in 5 kids with cleft palate have speech problems after surgical repair. Most often, this means that a child’s voice is hyper nasal (sounding like the child is talking through the nose). This happens because the palate doesn’t move well enough to prevent air from leaking out of the nose.
Children with clefts also can have other types of speech problems that aren’t to the cleft; for example, age-related errors such as saying “wed” instead of “red.” Sometimes, the dental problems associated with the cleft will distort some sounds, particularly “s,” “sh,” “ch,” and “j.”
A speech-language pathologist can check a child’s speech and language skills and recommend treatment if needed.