What is cleft lip and palate?

A cleft is an opening in the upper lip or the roof of the mouth (palate) when a baby is born.

They are one of the most common birth defects and can occur in the following ways:

• Cleft lip only
• Cleft palate only
• Both a cleft lip and palate

As the lip and palate develop separately, the above combinations can occur on one or both sides of the mouth.

What causes cleft lip and palate?

A cleft happens during the first 6 to 10 weeks of pregnancy. During this period, the baby’s upper jaw, nose and mouth fuse together to form the upper lip and roof of the mouth. The cleft happens when there is a failure to fuse completely. In most cases, the causes of cleft lip and palate are not known.

How is cleft lip and palate diagnosed?

Cleft lips can be diagnosed during prenatal ultrasound. Isolated cleft palate is harder to detect during the ultrasound as the lip will be obstructing the examination. Cleft lip and palate can also be detected during physical examination of the mouth, nose and palate of the newborn.

Why should the patient seek treatment?

Cleft lip and palate can cause significant issues.

Feeding issues – As there is an opening in the palate or lip, food and liquids can pass through the nose, or there is an incomplete seal of the lip. Babies adapt quickly, and feeding is not a major problem.

Ear infection and hearing loss – A cleft in the palate may lead to fluid build-up in the middle ear causing ear infections. Prolonged ear infections might lead to hearing loss.

Speech problem – Cleft lip and palate might result in a nasal voice in children with hard-to-understand speech. Surgery and sometimes speech therapy may fix these problems.

Dental problems – There may be issues such as missing or impacted dentition, requiring early treatment with the dentist.

What are the treatment options?

A team of professionals will be working with you to care for your child. They include:

• Paediatrician
• Plastic surgeon
• Ear, nose, and throat (ENT) surgeon
• Oral surgeon
• Orthodontist
• General dentist
• Speech-language pathologist
• Audiologist

Surgical intervention is carried out with the aims of repairing and restoring facial aesthetics, and ensuring the adequate function of the lip and palate.

The recommended schedule for surgery:

• Cleft lip repair at 3 – 6 months
• Palate repair at 6 –12 months
• Speech surgery at 5 – 6 years
• Alveolar bone grafting at 7 –13 years
• Orthognathic surgery (maxillary advancement) at 17 years and above
• Secondary soft tissue surgery and/or rhinoplasty at 17 – 18 years

• What to expect after treatment?

Patients will be reviewed regularly while undergoing treatment.