Cleft Lip and Palate: Types, Causes, Risks & Treatment

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What is Cleft Lip and Palate?

Orofacial clefts, specifically cleft lip/palate, is one of the most common head and neck birth defects. Clefts affect roughly 1 in 700 children worldwide.

Oral clefts appear as splits or openings in the upper lip, palate (roof of the mouth), or both. The splits cause gaps and defects in the affected areas. They are also usually associated with a nose deformity on the same side.

Half of all clefts involve both the lip and palate. A cleft that only affects the palate is a less common birth defect.

In the U.S., cleft lip/palates are most common in Native Americans, Asians, and Latinos. African Americans have the lowest risk of developing orofacial clefts.


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Serious medical and dental conditions typically occur in children who have cleft lips and/or palates, including:

  • Dental abnormalities, such as missing or misaligned teeth
  • Greater risk for cavities, due to weaker enamel and thicker saliva production
  • Hearing problems
  • Ear infections
  • Language and speech problems (speech therapy from a pathologist can help)
  • Abnormalities affecting the middle ear
  • Psychosocial issues (social and psychological aspects)

Types of Cleft Lip

Cleft lips can either be complete or incomplete, which means the splits may or may not extend to the nose. They can also develop on one side (unilateral) or on both sides (bilateral) of the upper lip.

There are a few types of cleft lips:

cleft lip and palate 04
Incomplete Unilateral

Clefts that develop on one side of the upper lip and do not extend into the nose.

complete unilateral cleft lip
Complete Unilateral

Clefts that develop on one side of the upper lip and extend into the nose.

cleft lip and palate 03
Incomplete Bilateral

Clefts that appear on both sides of the upper lip, but do not extend into the nose.

cleft lip and palate 07
Complete Bilateral

Clefts that appear on both sides of the upper lip and extend into the nose.

Types of Cleft Palate

Similar to cleft lips, cleft palates can either be complete or incomplete, which means the splits may involve the primary (front) palate, secondary (back) palate, or both.

There are a few types of cleft palates:

cleft lip and palate 08
Incomplete Cleft Palate

Clefts that develop in the soft palate (back of the mouth).

cleft lip and palate 08
Complete Cleft Palate

Clefts that develop in the soft and hard palate on one side of the mouth. The splits extend past the lips and into the nose.

cleft lip and palate 09
Unilateral Complete Cleft Palate and Lip

Clefts that develop in the soft and hard palate on one side of the mouth. The splits extend past the lips and into the nose.

cleft lip and palate 10
Bilateral Complete Cleft Palate and Lip

Clefts that develop in the soft and hard palate on both sides of the mouth. The splits extend past the lips and into the nose.

Submucous Cleft Palate

A submucous cleft palate affects the palate and uvula, which is the teardrop-shaped tissue that hangs in the back of your throat. The soft palate and uvula work together to prevent food from going up your nose.

Someone with a submucous cleft palate has a cleft underneath the mucous membrane. This type of cleft is "hidden" and will not be noticeable until the baby is born. It develops in about 1 in 1,200 babies.

What Causes Cleft Lip/Palate?

Clefts are birth defects, which means they form in the womb. Common reasons a child may develop a cleft lip and/or palate include:

  • Family history of cleft lip and palate (genetics)
  • Having diabetes during pregnancy is linked to birth defects, such as cleft lips
  • Obesity during pregnancy can increase the risk of cleft lip and palate
  • Exposure to unhealthy substances during pregnancy, such as cigarettes, alcohol, and some medications
  • Other environmental factors

Abnormalities Associated with Cleft Lip and Palate

Common abnormalities and syndromes associated with cleft lip and palate include:

  • Van der Woude syndrome — affects face development.
  • CHARGE syndrome — causes coloboma, heart defects, atresia choanae, and ear abnormalities.
  • Apert syndrome — causes abnormal skull growth and affects the shape of the face and head.
  • Pierre Robin sequence — a birth defect that results in a smaller jaw, breathing difficulties, and a tongue that falls back in the throat.
  • Kabuki syndrome — a congenital disorder that causes abnormal facial features.
  • Klippel Feil syndrome — causes neck and spine abnormalities and results in a shorter neck.
  • Stickler syndrome - causes eye abnormalities, hearing loss, joint problems, and a flattened facial appearance.
  • Treacher-Collins syndrome — causes ears, eyes, cheekbones, and chin deformities.
  • DiGeorge syndrome — a chromosomal disorder that can cause poor heart development, issues with the immune system, and a cleft palate.
  • Beckwith-Wiedemann syndrome — children with this syndrome have an abnormally large tongue, which results in breathing, swallowing, and speaking difficulties.
  • Goldenhar syndrome — a birth defect that causes poor development of the nose, soft palate, lips, mouth, and ears.

Phases of Treatment

Children who are born with a cleft lip, palate, or both require multiple phases of treatment starting from birth and into early adulthood (18+ years old). Treatment typically includes adhesions, repairs, surgeries, bone grafts, and orthodontic treatment.

Cleft lip and palate repairs are performed by a plastic surgeon, pediatric otolaryngologist, or an oral and maxillofacial surgeon with extensive training in pediatric craniomaxillofacial surgery. In addition, there are a few phases of treatment throughout childhood, depending on the child’s needs:

Birth — Infant Orthopedic Treatment, Lip Repair, and Lip Adhesion

From birth, children with a cleft lip and palate require pre-surgical infant orthopedics (PSIO). In particular, this procedure reshapes nasal and alveolar segments before cleft lip surgery. A cleft lip is repaired between 3 and 6 months of age. A nasolabial (lip) adhesion may also be necessary before repairing the cleft lip to reduce tension and speed up the recovery process.

1 Year — Palate Repair

Cleft palate repairs are completed between 9 and 18 months of age, typically around age 1. Early palate repair allows for better speech development. Repairing the defect early creates more scar tissue and may lead to improper growth of the mouth, improper bite, and poor facial esthetics.

Orthodontic treatment is typically necessary later on to correct these issues. If palate repair is completed after 18 months of age, speech can be negatively impacted.

2-3 Years — Velopharyngeal Surgery

Velopharyngeal insufficiency (VPI) occurs when the soft palate does not close tightly against the back of the mouth, which leads to abnormal speech and/or hypernasality. Velopharyngeal surgery is completed around 3 years of age if a child’s speech does not improve.

5-9 Years — Alveolar Bone Grafts and Maxillary Expansion

After a cleft lip and palate repair, a surgeon performs alveolar bone graft surgery a few years later. In short, the surgery adds bone to the gum ridge in children born with clefts. In addition, the bone graft must be completed as a child begins to lose their baby teeth and before permanent teeth grow in.

11 Years — Orthodontic Treatment (Phase I)

As baby teeth fall out and permanent teeth grow in (mixed dentition phase), the first round of orthodontic treatment takes place. Orthodontic treatment aligns the roof of the mouth, fixes crossbites, creates space for erupting permanent teeth, and treats impacted teeth.

13-15 Years — Orthodontic Treatment (Phase II)

By age 13, all permanent teeth have erupted. An additional phase of orthodontic treatment may also be necessary to align teeth and fix any dental abnormalities.

18+ Years — Orthognathic Surgery and Final Restorative Care

Orthognathic surgery is an operation that corrects the alignment of the jaws. It may be necessary after the cleft lip repair, bone graft surgery, and orthodontic treatment.

Cleft Lip/Palate FAQs

What causes a cleft palate during pregnancy?

What a mother drinks and eats during pregnancy may cause a cleft lip/palate. Certain medications, as well as environmental factors, can also contribute to the development of craniofacial anomalies.

One study found that cleft lip and cleft palate may be linked to low folic acid intake, in addition to abusing alcohol and smoking, while pregnant.

What stage of pregnancy does cleft palate develop?

A baby's mouth and nose develop between the 5th and 12th weeks in a mother’s womb. A primary cleft palate will form during early pregnancy, between the 4th and 7th weeks. A secondary cleft palate will develop between the 8th and 12th weeks of pregnancy.

Can cleft lip and palate be detected in ultrasound?

A cleft lip is easier to detect in an ultrasound than a cleft palate that occurs alone. In many cases, a cleft lip will appear in an ultrasound around 13 weeks (after the baby's nose and mouth fully develop).

Can a baby with cleft lip/palate breastfeed?

Most babies who have cleft lips and cleft palates can still breastfeed. Cleft palates, however, often make sucking more difficult.

How do you prevent cleft lip in babies?

Ways to help prevent cleft lip during pregnancy include:

  • Eat a balanced diet
  • Do not drink alcohol
  • Take folic acid supplements (600 micrograms per day)
  • Do not smoke cigarettes, recreational drugs, or other tobacco products
  • Make sure the medications you are taking during pregnancy are safe. Some medications that may cause cleft lip and palate include Accutane, methotrexate, seizure medications, and anticonvulsant medications
  • Make sure you are free from infections, gain a healthy amount of weight, and get prenatal care during pregnancy

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Resources

Ahlin, Jeffrey H. Maxillofacial Orthopedics: a Clin. Approach for the Growing Child. Quintessence Publ., 2003.

Angulo-Castro, E., Acosta-Alfaro, L., Guadron-Llanos, A., Canizalez-Román, A., Gonzalez-Ibarra, F., Osuna-Ramírez, I., & Murillo-Llanes, J. (2017, July). Maternal Risk Factors Associated with the Development of Cleft Lip and Cleft Palate in Mexico: A Case-Control Study. Retrieved August 19, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5554809/

“Cleft Lip and Palate.” CHLA, 9 July 2019, www.chla.org/cleft-lip-and-palate.

Development of Cleft Lip & Palate. (2019, April 29). Retrieved August 19, 2020, from https://med.virginia.edu/pediatrics/clinical-and-patient-services/patient-tutorials/cleft-lip-palate/development-of-cleft-lip-palate/

Nowak, Arthur J. Pediatric Dentistry: Infancy through Adolescence. Elsevier, 2019.

Sreejith, V., Arun, V., Devarajan, A., Gopinath, A., & Sunil, M. (2018). Psychological Effect of Prenatal Diagnosis of Cleft Lip and Palate: A Systematic Review. Retrieved August 19, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5968700/

Updated on: August 19, 2020
Author
Alyssa Hill
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Medically Reviewed: October 11, 2019
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Lara Coseo
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